040-pre-application-statement-of-intent- pasi

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document_type=form entity=format:application/pdf entity=language:ar language=en taxonomy_l1=transport taxonomy_l2=aviation taxonomy_l3=airline_licensing validity=valid validity_confidence=0.6

GACA
الطبيه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
PRE-APPLICATION STATEMENT OF INTENT - PASI
SECTION 1A. TO BE COMPLETED BY ALL APPLICANTS
<table><tr><td>1. Name and Mailing address of company</td><td colspan="2">2. Address of principal base where operations will be conducted(do not use post office box)</td></tr><tr><td></td><td colspan="2"></td></tr><tr><td>3. Proposed Start-up date</td><td colspan="2">4. Requested three-letter company identifier in order of preference 1. 2. 3.</td></tr><tr><td colspan="3"></td></tr><tr><td colspan="3">5. Management Personnel</td></tr><tr><td>Name (first, middle, Last)</td><td>Title</td><td>Telephone &amp; Email</td></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr></table>
SECTION 1B. TO BE COMPLETED BY AIR AGENCIES
6. Proposed type of agency and rating(s)
<table><tr><td colspan="2">□ Part 145 Repair Station</td><td colspan="2">□ Part 147 Maintenance Technical School</td></tr><tr><td rowspan="2">□ Domestic□ Foreign</td><td rowspan="2"></td><td colspan="2">□ Airframe□ Power plant</td></tr><tr><td colspan="2">□ Both (Airframe and Power plant)</td></tr><tr><td>□ Airframe□ Power plant</td><td>□ Incrustment□ Accessory</td><td colspan="2">□ Avionics</td></tr><tr><td>□ Propeller□ Powerplant□ Radio□ Other:</td><td>□ Specialized Service</td><td rowspan="2" colspan="2">□ Part 149 Parachute Loft</td></tr><tr><td colspan="3">□ Other:</td></tr></table>
SECTION 1C. TO BE COMPLETED BY ALL APPLICANTS
7. Additional information that provides a better understanding of the proposed operation or business (attach additional sheets, if necessary)
8. The statements and information contained on this form denote intent to apply for GACA certification.
<table><tr><td>Name and Title</td><td>Date</td><td>Signature</td></tr><tr><td></td><td></td><td></td></tr></table>
GACA-AVSES-AIR-F040
Rev: 5, Date: 28 Sep 25
Page 1 of 2

GACA
الهييه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
PRE-APPLICATION STATEMENT OF INTENT - PASI
<table><tr><td colspan="4">SECTION 2. TO BE COMPLETED BY GACA</td></tr><tr><td>Received by</td><td colspan="3"></td></tr><tr><td>Date</td><td colspan="3"></td></tr><tr><td>Remarks</td><td colspan="3"></td></tr><tr><td colspan="4">SECTION 3. TO BE COMPLETED BY GACA</td></tr><tr><td colspan="2">Pre-Certification No.</td><td></td><td>Received by</td></tr><tr><td colspan="2">Date coordinated with Airworthiness</td><td>Date</td><td></td></tr><tr><td colspan="2">Airworthiness representative assigned responsibility</td><td colspan="2"></td></tr><tr><td>Remarks</td><td colspan="3"></td></tr></table>
GACA-AVSES-AIR-F040
Rev: 5, Date: 28 Sep 25
Page 2 of 2