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Applicant Name：                                                             
 
License No.：                                                                 
 
License Category：                                                              
.
 
 
Signature of Aircraft, Engine Type & Rating Applied for：                           .
 
Training Descriptions
 
Training Organization Name：                                                   
 
Descriptions of Training Certificate Number or Reference Files：
 
Maintenance Experience in Respect of this Aircraft Type.
 
  
  Time                   Performed Maintenance                   Referee
 
 
 
.
 
 
Whether or not there is any serious maintenance error        Yes        No
.
 
 
I hereby apply for the signature of the aircraft type of the license for the civil aircraft 
 
maintenance personnel and ensure the faithfulness and correctness of all the application
 
materials while any incorrect information will affect the validity of my qualifications.
 
 
Signature:                              Date:                                 .
 
 
The applicant shall concurrently submit the materials as follows.
 
A copy of the certificate for the aircraft type training or the reference for the aircraft type 
 
training Reference files for the maintenance experience.
 
A list for the training & practice items on the aircraft type (if applicable).
.
.
 

F66-3(8/2005).
.

Annex IV
Application for the Issuance/Renewal of the License for the Civil Aircraft Component
maintenance personnel
 
 
 
Time                  Training Record                Referee
　
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本文鏈接地址：Management Rule of Civil Aircraft Maintenance Personnel Lice(14)