Operational Approvals Application

Instructions and advice for completing this Application Form

Note: The CAA Standard Rate hourly charge applies.
 Refer to Advisory Circular AC91-Ops1 for the instructions to complete this application.
 The charges associated with the operational approvals will be invoiced to the applicant.
 Applications must be submitted to CAA not less than 28 days prior to the date required.
 To reduce time and costs, this form is intended to be revised for additional applications after the initial
approvals for an aircraft type.

Brief Details
Make:       Model:      
Single aircraft Multiple aircraft (Complete Appendix A)

Application Type: New Application

Change being made:      

Revision History
Revision No:       Date:      
CAA Work Request No:       (To be completed by the CAA)

Part A – Details of Applicant

Name of Operator:            

Client ID No. (if known)

Address for Service: Civil      

Aviation Act, s8, requires applicants to
provide an address for service (ie, a      
physical address) and to promptly notify
the Director of any changes.
     

     

Tel:       Fax:       Email:      

Postal Address: (If      
different from Address for
Service.)
     
     
Tel:       Fax:       Email:      
Person or organisation who can be contacted for further information concerning this application:
Name:      
Designation:      
Address:      
     
Tel:       Mob:       Email:      

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 Operational Approvals Application

Approvals Sought: (Check those required)

RVSM ILS Cat II ILS Cat III

EDTO:
120 min 180 min 210 min 240 min

Navigation

RNP 10 RNAV 5 RNAV 2 RNAV 1

RNP 4 RNP 2 Basic RNP 1 Advanced RNP
RNP APCH RNP AR Ops
RF Legs Baro VNAV LPV
FANS 1/A

ADS-B Out

CASA CAO 82.5 EASA AMC 20-24

RTCA DO-260A RTCA DO-260B

ADS-C

TBD

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 Operational Approvals Application

Part B – Aircraft and Equipment Details

Make:       Model:      
Serial No:       Line No:       Variable No:      
Registration Mark:     CAA Aircraft ID:       Mode S Code (hex): C8XXXX

Aircraft History:
New Used
Previous Registration:      
Previous Operator:      
State / Country:      

For multiple aircraft of the same make and model complete the continuation sheet in Appendix A.

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 Operational Approvals Application

Aircraft Documentation
(Insert document number, revision / date and reference information)

Flight Manual:
Air No:       Manufacturer No:       Rev:      

RVSM Approvals
AFM Reference      
SIL / SB      

Navigation Approvals
AFM / Approval Doc References      
AFM / Approval Doc References      
AFM / Approval Doc References      

ADS-B Approvals
Approvals held Nil
AFM Reference      
Relevant Approval Doc      

ADS-C Approvals      

Aircraft ELA      

Aircraft Software Configuration List      

Maintenance Planning Document      

Aircraft Maintenance Manual      

IPC      

Wiring Diagram Manual      

Structural Repair Manual      

Configuration Deviation List      

MMEL      

Operator MEL / DDPG      

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 Operational Approvals Application

Aircraft Equipment Details

Communications Systems
(Insert Make, Model & P/N)

Qty installed

VHF Model       0

HF Model       0
SATCOM Model      
SATCOM Data       0
SATCOM Voice       0
Is SCV integrated to audio, CVR and FDR systems? No
Is an Exemption against §91.519 held for this aircraft? No Exemption No:      

Navigation Systems
Qty installed
Inertial Reference System
Model       0
Part No      

Air Data Computers Model

Model       0
Part No      

GNSS
Model       0
Part No      

DME
Model       0
Part No      

Flight Management Computer

Model       0
Part No      
Software Version      

Flight Control Computer

Model       0
Part No      
Software Version      

Mode Control Panel

Model      
Part No      

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 Operational Approvals Application

Pitot Static Probes

Model / Part No       0

Angle of Attack Vanes

Model / Part No       0

Surveillance Systems

Transponder 1
Model       Mode S 0
Part No      
Software Version      
ELS EHS Extended Squitter

Transponder 2
Model       Mode S 0
Part No      
Software Version      
ELS EHS Extended Squitter

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 Operational Approvals Application

Part C – Continued Airworthiness

Maintenance Organisation

Contact Details:
Name:      
Phone:       Mobile:       Email:      
Maintenance facilities to be used:      
Procedures for managing maintenance providers:      
Part 43 specified maintenance completed:
Part 43 App B Radio Station Inspection
Part 43 App D Altimeter Systems Tests & Inspections
Part 43 App E ATC Transponder Tests & Inspections

Comments:      

Maintenance Practices
(Insert document number, revision / date and reference information)

Maintenance schedule      

Configuration management      
Modifications / Repairs      
Maintenance Practices      
Use of BITE      
Static System Maintenance      
Skin Waviness Checks      

Non-Compliant Aircraft
Notification Procedure (maintenance)      
Notification Procedure (operations)      
Notification Procedure (CAA)      
Corrective Action Procedures      

Maintenance Training
Test Equipment      
Documentation      

RVSM Test Equipment

Accuracy (0.01% or 4:1)      
Calibration Schedule      
Audit Programme      
Maintenance Practices      

Comments:      

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 Operational Approvals Application

Part D – Operational Training and Competency

Contact Details:
Name:      
Phone:       Mobile:       Email:      
Training programme submitted:
RVSM
PBN: RNAV & RNP
FANS 1/A
ADS-B
ADS-C

Operator Practices and Procedures - RVSM

Flight Planning      
Pre-Flight      
Procedures prior to RVSM airspace entry      
In-Flight Procedures      
ATC Phraseology      
NAT Airspace Procedures      
Verification / Monitoring Programme      

Operator Practices and Procedures – PBN: RNAV & RNP

Flight Planning      
Pre-Flight      
Procedures prior to RNP airspace entry      
In-Flight Procedures      
ATC Phraseology      
Special Airspace Procedures      
Training      

Operator Practices and Procedures – RNP / FANS 1/A

Flight Planning      
Pre-Flight      
Procedures prior to RNP airspace entry      
In-Flight Procedures      
ATC Phraseology      
Special Airspace Procedures      
Training      

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 Operational Approvals Application

Operator Practices and Procedures – ADS-B / ADS-C

Flight Planning      
Pre-Flight      
Procedures prior to ADS-B airspace entry      
In-Flight Procedures      
ATC Phraseology      
Special Airspace Procedures      
Training      

Crew training completed:

Comments:

     

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 Operational Approvals Application

Part E – Applicants Declaration

I am signing this form as:

A Senior Person in a Part 119 Certificated operator.
Owner / operator of an aircraft engaged in Part 91 operations only.
Agent or representative of an OWNER / OPERATOR of an aircraft engaged in Part 91 operations only.
Giving false or misleading information is an offence under the regulations.

1. I declare that the information provided in this application form is true and correct.
2. I understand that the information provided in this application will allow CAANZ to calculate an estimate
for service for processing this application.
3. I understand and agree that the cost estimate may change, and processing the application may be
delayed if:
 the application does not accurately and completely identify my/our requirements; or
 the details in this application are subsequently changed; or
 adequate supporting documentation has not been provided.
4. I understand and agree that for CAANZ to proceed with this application, I must:
 accept the cost estimate,
 forward the prescribed payment; and
 forward all supporting documentation to CAANZ.
5. If I am signing this application as an agent, I declare that I have obtained the necessary Power of
Attorney authorising me to sign on behalf of the applicants.

Name:       Date:      

There is no signature required on this form; the presence of the name of the individual in this field is deemed
to be a signature.

Part F – Submitting Your Application

Have you attached all required documentation as indicated throughout the application? All supplemental
information should be in an electronic format.

After reviewing your application, CAANZ will advise you if any additional information is required.

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 Operational Approvals Application

Part G – CAA Assessment

1. Airworthiness:
a. RVSM:
i. The aircraft meets the airworthiness requirements specified in AC 91-4
approval for RVSM operations.
ii. Aircraft has dual independent communications:
VHF HF HF + SCV
iii. Aircraft meets the requirements for: Being assessed.
iv. Aircraft inspection required: No
v. Inspection sheet raised:
b. The aircraft meets the airworthiness requirements specified in AC 91-XX for the
following navigation operations:
i. RNP 10 (RNAV 10)
ii. RNAV 5 (BRNAV)
iii. RNAV 2
iv. RNAV 1 (PRNAV)
v. RNP 4
vi. RNP 2
vii. Basic RNP 1
viii. RNP 0.3
ix. RNP APCH
x. RNP AR Operations
xi. Baro VNAV
xii. LPV
xiii. RF legs
xiv. FANS 1/A
xv. Inertial only navigation time for RNP 10: x.x hours
xvi. Inertial only navigation time for RNAV 5: x.x hours
Conditions / limitations / comments:
     
c. The aircraft meets the airworthiness requirements specified in AC 91-XX for ADS-B
operations in airspace with the following requirements:
i. CASA CAO 82.5
ii. EASA AMC 20-24
iii. RTCA DO-260A
iv. RTCA DO-260B
Conditions / limitations / comments:
     

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 Operational Approvals Application

d. The aircraft meets the airworthiness requirements specified in AC 91-XX for ADS-C
operations in airspace with the following requirements:
i. TBD
Conditions / limitations / comments:
     

2. Continued Airworthiness:
a. The aircraft operator is already approved for the conduct of the operations requested
for the same aircraft make and model; and
b. There are no significant differences from previously approved aircraft;

or
c. The aircraft operator has the capability of maintaining the aircraft in compliance with
its type design and AC 91-4 for the conduct of RVSM operations;
d. The aircraft operator has the capability of maintaining the aircraft in compliance with
its type design and AC 91-XX for the conduct of the navigation operations listed in 1. b
above.
e. The aircraft operator has the capability of maintaining the aircraft in compliance with
its type design and AC 91-XX for the conduct of operations requiring ADS-B listed in
1. c above.
f. The aircraft operator has the capability of maintaining the aircraft in compliance with
its type design and AC 91-XX for the conduct of the ADS-C operations listed in 1. d
above.

3. Flight Operations:
a. The aircraft operator is already approved for the conduct of the operations requested
for the same aircraft make and model; and
b. There are no significant differences from previously approved aircraft;

or
c. The aircraft operator has been assessed as having the required training and
operational competency for the conduct of RVSM operations in accordance with CAR
§91 and AC 91-4 in domestic and oceanic airspace.
d. The aircraft operator has been assessed as having the required training and
operational competency for the conduct of the navigation operations listed in 1. b
above in accordance with CAR §91 and AC 91-XX.
e. The aircraft operator has been assessed as having the required training and
operational competency for the conduct of operations in airspace requiring ADS-B as
listed in 1. c above in accordance with CAR §91 and AC 91-XX.
f. The aircraft operator has been assessed as having the required training and
operational competency for the conduct of operations in airspace requiring ADS-C as
listed in 1. D above in accordance with CAR §91 and AC 91-XX.

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 Operational Approvals Application

Part G – CAA Approval

Approval Recommendation

Airworthiness In assessment

Name:       Date:      

Continued Airworthiness In assessment

Name:       Date:      

Flight Operations In assessment

Name:       Date:      

Manager Flight Operations Approval

The operations identified in Part G Section 1 are In assessment subject to the conditions and
limitations specified below:

Conditions and Limitations

     

     

Manager Flight Operations Approval

Name:       Date:      

Approval Completion
1. RVSM inspection report received and satisfactory
(if required). Not required
2. Letter(s) of Authorisation issued.
3. Ops Specs revised and approved.
4. For RVSM, PARMO Form F2 submitted.
5. For RVSM, CAA Registration database updated.
6. ACU Operational Approvals database updated.

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 Operational Approvals Application

Appendix A: Additional Aircraft

Aircraft 2
Make:       Model:      
Serial No:       Line No:       Variable No:      
Registration Mark:     CAA Aircraft ID:       Mode S Code (hex): C8XXXX

Aircraft History:
New Used
Previous Registration:      
Previous Operator:      
State / Country:      

Approval Completion

1. RVSM inspection report received and satisfactory

(if required). Not required
2. Letter(s) of Authorisation issued.
3. Ops Specs revised and approved.
4. For RVSM, PARMO Form F2 submitted.
5. For RVSM, CAA Registration database updated.
6. ACU Operational Approvals database updated.

Aircraft 3
Make:       Model:      
Serial No:       Line No:       Variable No:      
Registration Mark:     CAA Aircraft ID:       Mode S Code (hex): C8XXXX

Aircraft History:
New Used
Previous Registration:      
Previous Operator:      
State / Country:      

Approval Completion

1. RVSM inspection report received and satisfactory

(if required). Not required
2. Letter(s) of Authorisation issued.
3. Ops Specs revised and approved.
4. For RVSM, PARMO Form F2 submitted.
5. For RVSM, CAA Registration database updated.
6. ACU Operational Approvals database updated.

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 Operational Approvals Application

Aircraft 4
Make:       Model:      
Serial No:       Line No:       Variable No:      
Registration Mark:     CAA Aircraft ID:       Mode S Code (hex): C8XXXX

Aircraft History:
New Used
Previous Registration:      
Previous Operator:      
State / Country:      

Approval Completion

1. RVSM inspection report received and satisfactory

(if required). Not required
2. Letter(s) of Authorisation issued.
3. Ops Specs revised and approved.
4. For RVSM, PARMO Form F2 submitted.
5. For RVSM, CAA Registration database updated.
6. ACU Operational Approvals database updated.

Aircraft 5
Make:       Model:      
Serial No:       Line No:       Variable No:      
Registration Mark:     CAA Aircraft ID:       Mode S Code (hex): C8XXXX

Aircraft History:
New Used
Previous Registration:      
Previous Operator:      
State / Country:      

Approval Completion
1. RVSM inspection report received and satisfactory
(if required). Not required
2. Letter(s) of Authorisation issued.
3. Ops Specs revised and approved.
4. For RVSM, PARMO Form F2 submitted.
5. For RVSM, CAA Registration database updated.
6. ACU Operational Approvals database updated.

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