3750 edition 6 PDF [263.5 KB] - Ministry of Defence

D - MISCELLANEIOUS
1. Information regarding reporting aircraft
a) Aircraft registration ______________________________________________________________
b) Aircraft type ____________________________________________________________________
c) Operator _______________________________________________________________________
d) Aerodrome of departure __________________________________________________________
e) Aerodrome of first landing _____________________ destination ________________________
f) Type of air traffic service _______________________ #
g) RT frequency ________________ SSR code ___________________ #
h) Reported by radio or other means to _____________ (name of ATS uniti) at time _________UTC
i) Date / time / place of completion of form _______________________________________________
2. Function, address and signature of person submitting report
a) Function _________________________________________________________________________
b) Address _________________________________________________________________________
c) Signature ________________________________________________________________________
d) Telephone number ________________________________________________________________
3. Function and signature of person receiving report
a) Function ________________________ b) Signature _____________________________________
E. SUPPLEMENTARY INFORMATION BY ATS UNIT CONCERNED
1. Receipt of report
a) Report received via AFTN / radio / telephone / other (specify)* ____________________________
b) Report received by _______________________________ (name of ATS unit)
# Addition to the ICAO form.
A - 3