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Date d'expiration
1 1 (Signature of holder)
Front of CMC
Issuing State
The holder may, at all times, re-enter upon
production of this certificate, within the
period of validity.
(Signature)
Issued athmis B Issuing Authority1
(Place of issue) Autorite d'emission
Machine Readable Zone
(To be left blank when non-machine readable
certificate issued)
Back of CMC
Note.- Detailed specifcations for a machine readable crew member certificate can be found in Doc 9303,
Part 3 - Size 1 and Size 2 Machine Readable Official Travel Documents.
ANNEX 9 APP 7-1
APPENDIX 8. CIVIL AVIATION SAFETY INSPECTOR CERTIFICATE
/ Issuing State CIVIL AVIATION
Competent issuing authority SAFETY INSPECTOR
CERTIFICATE
Photograph
of holder of
Certificate
Surname/Nom Given name/Prinom
Sex/ Nationality/ Date of Birth/
Sexe Nationalite! Date de Naissance
Employed by/ Occupation/
Employeur Profession
CIVIL AVIATION
SAFETY INSPECTOR
Doc No/P du Doc Date of Expiry/
Date d'expiration
(Signature of holder)
Front of Certificate
Issuing State
The holder may, at all times, re-enter upon
production of this certificate, within the
Issuedp earitold~ mofi vsia lidity. 1
(Place of issue)
(Signature)
Issuing Authority/
Autorite d'kmission
I Machine Readable Zone
(To be left blank when non-machine readable I certificate issued) I
Back of Certificate
Note.- Detailed specifications for a machine readable certifcate can be found in Doc 9303, Part 3 - Size 1
and Size 2 Machine Readable Official Travel Documents.
ANNEX 9 APP 8-1
APPENDIX 9. SUGGESTED FORMATS FOR DOCUMENTS
RELATING TO THE RETURN OF INADMISSIBLE PERSONS
1. ATTESTING DOCUMENT RELATING TO LOST OR DESTROYED
TRAVEL DOCUMENTS (see 5.6)
From: Immigration or other appropriate authority: (Name) To: Immigration or other appropriate authority: (Name)
Airport: (Name) Airport: (Name)
State: (Name) State: (Name)
Telephone:
Telex:
Facsimile:
The person for whom this document is issued arrived on (date) at (name of) Airport on flight (flight number) from (City and
State).
This person, who was found to be inadmissible, has lost or destroyed his travel documents and claims to belis understood to
be (strike out whichever is not applicable and add any appropriate supporting information).
Surname:
Given name@):
Date of birth:
Place of birth:
Nationality:
Residence:
The incoming carrier was instructed to remove the passenger from the territory of this State on flight (flight number) departing
on (date) at (time) from (name of) airport.
Pursuant to Annex 9 to the Convention on International Civil Aviation, the last State in which a passenger previously stayed
and most recently travelled from is invited to accept him for re-examination when he has been refused admission to another
State.
Date: Name of Official:
Title:
Signature:
Name of immigration or other appropriate authority:
(Warning: This is NOT an Identification Document)
ANNEX 9 APP 9-1
Annex 9 -Facilitation Appendix 9
2. LETTER RELATING TO FRAUDULENT, FALSIFIED OR COUNTERFEIT TRAVEL DOCUMENTS
OR GENUINE DOCUMENTS PRESENTED BY IMPOSTERS (see 5.7)
From: Immigration or appropriate authority: (Name) To: Immigration or appropriate authority: (Name)
Airport: (Name) Airport: (Name)
State: (Name) State: (Name)
Telephone:
Telex:
Facsimile:
Enclosed herewith is a photocopy of a fraudulent/falsified/counterfeit passporthdentity cardlgenuine document presented by an
imposter.
Document number:
State in whose name this document was issued:
The above-mentioned document was used by a person claiming to be:
Surname:
Given name(s):
Date of birth:
Place of birth:
Nationality:
Residence:
Photograph
if available
This person arrived on (date) at (name of) Airport on flight (flight number) from (City and State).
The holder was refused entry to (name of State) and the incoming carrier has been instructed to remove the passenger from the
territory of this State on flight (flight number) departing at (time) and (date) from (name of airport).
The above-mentioned document will be required as evidence in the holder's prosecution and has been impounded. As this
document is the property of the State in whose name it was issued, it will be returned, following prosecution, to the appropriate
authorities.
According to Annex 9 to the Convention on International Civil Aviation, the last State in which a passenger previously stayed
and most recently travelled from is invited to accept him for re-examination when he has been refused admission to another
　
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