Application Form for FSTD (Aeroplane) Initial Qualification

Form No. FOD.F.801bVersion No. 4Issue Date: 20/06/2011APPLICATION FORM FOR FSTD(AEROPLANE) INITIALQUALIFICATIONAPPLICATION FORM FOR FSTD (AEROPLANE) INITIAL QUALIFICATION (ACJ No 1 toJAR FSTD A.015)Application for initial evaluation of a Flight Simulation Training Device (FSTD), (except BITD).Part ATo be submitted not less than 3 months prior to requested qualification date1. Type of FSTD applied for:Type of FSTD Aircraft Aircraft Type. Class Qualification Level SoughtFlight Simulator (FFS) A B C DFlight Training Device (FTD) 1 2Flight and NavigationProcedure Trainer (FNPT)I II II MCC2. Applicant Details:The applicant requests the evaluation of its Flight Simulation Training Device for JAR-FSTD Aqualification.2 (a) Name of Simulator Operator: ..........................................................................2 (b) AOC Number or TRTO Number (if applicable): …………………….…………...2 (c) Address: .....................................................................................................................................................Postcode: ..................................................... Country: ..............................................2 (d) Postal Address (if different from above): ………………………………………………………………………...Postcode: ..................................................... Country: ..............................................2 (e) Contact detailsTitle: …………..Surname: ............................................................ Forename: ……………….….........................Phone No.: .............................................................. Mobile No: ............................................................................Fax No: .....................................................................E-mail address: ....................................................................3. Defined Detail:The FSTD with its Visual System is fully defined on the accompanying Qualification Test Guide (QTG).Please define details below:3 (a) FSTD Manufacturer Name: .......................................................................................3 (b) Visual System Manufacturer Name (if applicable). ....................................................3 (c) Both 3 (a) and 3(b) are fully defined on what page(s) of the QTG: ............................3(d) QTG run on (date) ……………………….. and location? ..............................................3 (e) IAA FSTD reference Number (if known): ……………………………………….………...Page 1 of 4

Form No. FOD.F.801bVersion No. 4Issue Date: 20/06/2011APPLICATION FORM FOR FSTD(AEROPLANE) INITIALQUALIFICATION4. Evaluation:4 (a) Evaluation is requested for the following configurations and engine fits as applicable:e.g. 767 PW/GE and 757RR1. ..................................................................................... 2. ...............................................................................3. ..................................................................................... 4. ...............................................................................4(b) Date requested: ……………………………………...4 (c) FSTD will be located at: ……………….……………4 (d) QTG submitted by date (dd/mm/yyyy): …………………………...Note: The QTG must be submitted not less than 30 days before the requested evaluation date unless otherwiseagreed with the Authority.5. Comments:6. Signature Block:Signature: .......................................................................................Date (dd/mm/yyyy): .........................................Name : ............................................................................................Position: ……....................................................7. Submissions and EnquiriesThis Form should be completed and submitted together with the appropriate application fee to:Mail to:Flight Operations DepartmentIrish Aviation AuthorityThe Times Building11-12 D’Olier StreetDublin 2Enquiries:Email: fod@iaa.ieSubject: FSTD Initial qualificationTel: +35316031148Fax: +35316774460Note: See fees Order Irish Aviation AuthorityIAA use only:Received onAmount €Receipt Number:Enclosures:Page 2 of 4

Form No. FOD.F.801bVersion No. 4Issue Date: 20/06/2011APPLICATION FORM FOR FSTD(AEROPLANE) INITIALQUALIFICATIONJAR APPLICATION FORM FOR FSTD (AEROPLANE) INITIAL QUALIFICATIONPart B To be completed with attached QTG results.1. Applicant Details:1 (a) Name of Simulator Operator: ......................................... 1. (b) Aeroplane Type Applied For: …………………1 (c) AOC Number or TRTO Number (if applicable): ………………………………...1 (d) IAA FSTD reference Number (if known): ………………………………..……………....1 (e) Contact details: Title: …………..Surname: ...................................... Forename: ……………….….................Phone No.: .............................................................. Mobile No: ............................................................................Fax No: .....................................................................E-mail address: ....................................................................2. Declaration:2 (a) We, the above named operator, have completed tests of the FSTD and declare that it meets all applicablerequirements of the JAR– FSTD A (Aeroplane) except as noted below. Appropriate hardware and softwareconfiguration control procedures have been established and these are appended for IAA inspection andapproval.2 (b) The following MQTG tests are outstanding (add boxes as required):TestsCommentsIt is expected that they will be completed and submitted 3 weeks prior to the evaluation date.3. Signature BlockSignature: ........................................................................................Date (dd/mm/yyyy): .........................................Name : ............................................................................................Position: ……....................................................4. Submissions and EnquiriesThis Form should be completed and submitted to:Mail to:Flight Operations DepartmentIrish Aviation AuthorityThe Times Building11-12 D’Olier StreetDublin 2Enquiries:Email: fod@iaa.ieSubject: FSTD Initial qualificationTel: +35316031148Fax: +35316774460Page 3 of 4

Form No. FOD.F.801bVersion No. 4Issue Date: 20/06/2011APPLICATION FORM FOR FSTD(AEROPLANE) INITIALQUALIFICATIONJAR APPLICATION FORM FOR FSTD (AEROPLANE) INITIAL QUALIFICATIONPart C To be completed not less than 7 days prior to initial evaluation1. Applicant Details:1 (a) Name of Simulator Operator: ......................................... 1. (b) Aeroplane Type Applied For: …………………1 (c) AOC Number or TRTO Number (if applicable): ………………………………...1 (d) IAA FSTD reference Number (if known): ………………………………..……………....1 (e) Contact details: Title: …………..Surname: ...................................... Forename: ……………….….................Phone No.: .............................................................. Mobile No: ............................................................................Fax No: .....................................................................E-mail address: ....................................................................2. The FSTD has been assessed by the following evaluation team:NameQualificationNamePilot Licence NumberNameFlight Engineer’s Licence Number (if applicable)3. Declaration3 (b) The above named team attest(s) it conforms to the aeroplane flight deck configuration of the above namedoperator (1a) and aeroplane type (1e) and that the simulated systems and subsystems function equivalently tothose in that aeroplane.The pilot(s) listed in 2. has also assessed the performance and the flying qualities of the FSTD and finds that itrepresents the designated aeroplane.4. Additional comments (as required)5. Signature BlockSignature: ........................................................................................Date (dd/mm/yyyy): .........................................Name : ............................................................................................Position: ……....................................................6. Submissions and EnquiriesThis Form should be completed and submitted to:Mail to:Flight Operations DepartmentIrish Aviation AuthorityThe Times Building11-12 D’Olier StreetDublin 2Enquiries:Email: fod@iaa.ieSubject: FSTD Initial qualificationTel: +35316031148Fax: +35316774460Page 4 of 4