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Application for Aero-Medical Centre (AeMC) Organisation Approval Civil Aviation Directorate


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Application for Aero-Medical Centre (AeMC) Organisation Approval

Civil Aviation Directorate




Transport Malta, Luqa Airport, Luqa LQA 3290 Malta. Tel:+356 2555 2365 Fax:+356 2123 9278 info.tm@transport.gov.mt www.transport.gov.mt


To: Transport Malta – Civil Aviation Directorate

Applicant Details


Full Name:




ID Card/ Passport:




Address:




Contact Number:




E-mail Address:






AeMC (to be approved) Details


Name (of AeMC):




Address (of AeMC):




Requesting Certification Approval for:

Class 1 Class 2 Class 3 LAPL

 Initial Approval

 Change of Approval*

 Grandfathering Request*

* Attach a copy of previous certificate



Head of AeMC Details


Full Name:




AME Certificate Reference:




Class 1 privileged since:

(dd/mm/yyyy)



Documents and manuals to be submitted with application


 List and qualifications of all AME’s, medical staff and supporting specialist consultants and whether they work full time or part time.

 Staff training records

 Head of AeMC CV

 Documents of clinical attachment, or liaison with designated hospitals, or medical institutes

 Management System Documentation

 Compliance Monitoring System Documentation




 Other Manual(s)




 I hereby request TM CAD to provide a quote for the estimated total charges related to this application. TM CAD is to continue the processing of this application only after the quote has been accepted. I am aware that the provision of a quote will lead to a delayed project start.



If answers to any of the above questions are incomplete:

Please provide full details of alternative arrangements separately.



I declare that I have the legal capacity to submit this application to TM- CAD and that all information provided in this application form and documentation attached to it is correct, complete and in compliance with ORA.GEN.115 and ORA.AeMC.115 of Commission Regulation (EU) No 290/2012.

I, the applicant identified above, certify that all the above named persons are in compliance with the applicable requirements.











Date

Name of Accountable Manager

Signature

Application form has to be signed by the accountable manager

This Application and the additional documentation should be sent by e-mail or regular mail to:

Transport Malta- Civil Aviation Directorate


Aero-Medical Section
Luqa Airport
Luqa, LQA 3290
Malta

E-mail: paul.sciriha@transport.gov.mt






Form TM/CAD/0201 Issue 1 March 2014 Transport Malta is the Authority for Transport in Malta set up by ACT XV of 2009 Page of 2




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