053-lsa-application-for-aircraft-certificate-of-authorization

gaca_gov_sa · form · processed · 1 chunks

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

GACA
الهييه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
LSA - APPLICATION FOR AIRCRAFT CERTIFICATE OF AUTHORIZATION
1. APPLICATION
Initial Issue
□ Renewal
□ Other
2. NAME AND ADDRESS
A. Official Name of Owner / Operator
B. Official Address of Principal Base where Operation is conducted
C. Official E-mail address of Owner / Operator
3. PERSONNEL IN CHARGE
Name
Title
Telephone
Email
4. SPECIAL OPERATIONS LIMITATION
□ A1 Issuance and Applicability
□ Other:
5. AIRCRAFT DATA
<table><tr><td>Aircraft Reg</td><td>Aircraft Make</td><td>Model</td><td>Serial No.</td><td>Year Of Manufacture</td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr></table>
6. DECLARATION
I hereby certify that the information provided above, and the aircraft documentations are true and correct. The aircraft has been physically inspected by an authorized agent, and found to be airworthy and in safe condition to fly.
<table><tr><td>Date</td><td>Name &amp; Title</td><td>Authorized Signature</td></tr><tr><td></td><td></td><td></td></tr></table>
7. FOR GACA USE ONLY
This aircraft documentation has been reviewed, and found to be satisfactory for the purpose of initial issuance / renewal of the Certificate of Authorization.
<table><tr><td colspan="4">Issuance Certificate of Authorization □ Recommended □ Not Recommended</td></tr><tr><td>Date</td><td>Name(Authorized Inspector)</td><td>Title</td><td>Signature</td></tr><tr><td></td><td></td><td></td><td></td></tr></table>
GACA-AVSES-AIR-F053
Rev: 2, Date: 07 Sep 25
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