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PERSONAL DATA
Title
Mr.
Ms.
Dr
(required)
First Name
(required)
Last Name
(required)
Date of Birth (e.g. 25/12/1980)
(required)
Nationality
(required)
Passeport Number
(required)
Corporate Name
Address
(required)
PO BOX
Zip code
(required)
City
(required)
Region
Country
(required)
Business Phone
(required)
Cell Phone
(required)
Fax
Email
(valid email required)
Website
USUAL AIRCRAFT
Do you own more than one aircraft
Yes
No
(required)
Registration of the aircraft you usually fly
(required)
Aircraft Type (e.g. PA32, R44, DR400, etc.)
(required)
Serial Number
Do you own a part of this aircraft
Yes
No
Are you the only owner of that aircraft (incl. via a Trust)
Yes
No
Name of the US Trust owning your aircraft
Location of the US Trust owning your aircraft
Home Base
(required)
IFR equipped
Yes
No
CPL qualified aircraft
Yes
No
Insurance (name and location)
Registration of other owned aircraft(s) (incl. via Trusts)
Type of other owned aircraft(s)
LICENSES
FAA PPL
Yes
No
(required)
FAA Instrument rating
Yes
No
(required)
FAA CPL
Yes
No
(required)
FAA other pilot liences/ratings
JAA/FCL PPL
Yes
No
(required)
JAA/FCL Instrument rating
Yes
No
(required)
JAA/FCL CPL
Yes
No
(required)
JAA/FCL other pilot liences/ratings
Any other pilot licences/ratings
Total Flight Experience (hours)
(required)
Flight Experience last 12 months (hours)
Med. Certif.: Class 1/Classe 2/Classe 3...?
form designer