gaca_gov_sa · form · processed · 3 chunks
GACA العربيه العابه للطيران المدني General Authority of Civil Aviation APPLICATION FORM FOR AERODROME CERTIFICATION OR AUTHORIZATION (Information to be filled with by the Applicant/Aerodrome Operator) INSTRUCTIONS a) This form is to be filled in by the Applicant/Aerodrome Operator for the issuance of aerodrome certificate or authorization. b) No part must be left blank. Write Not Applicable, if the information to be filled does not pertain to the aerodrome. c) For any clarification contact the General Manager (Aerodrome Standards Department) of General Authority of Civil Aviation, Kingdom of Saudi Arabia 1. PARTICULARS OF THE REQUIREMENT Please tick mark (√) one of the box applicable to requirement of applicant/aerodrome operator <table><tr><td>□ Initial Certification</td><td>□ Renewal Certification</td></tr><tr><td>□ Initial Authorization</td><td>□ Renewal Authorization</td></tr></table> 2. PARTICULARS OF THE APPLICANT Please tick mark (√) one of the box applicable to requirement of applicant/aerodrome operator <table><tr><td>Full Name</td><td colspan="3"></td></tr><tr><td>Position/Title</td><td colspan="3"></td></tr><tr><td>Address</td><td colspan="3"></td></tr><tr><td>Phone</td><td></td><td>Mobile</td><td></td></tr><tr><td>Email</td><td></td><td>Fax</td><td></td></tr></table> 3. DETAILS OF THE AERODROME SITE Aerodrome Name Geographical Coordinates of the Aerodrome Reference Point in degrees, minutes and seconds of WGS-84 format. Longitude Latitude 4. IS APPLICANT/AERODROME OPERATOR THE OWNER OF AERODROME SITE? Please tick mark (√) one of the boxes □ Yes □ No, : If No, Provide a) Details of Rights Held/Lease Deed in Relation to the Site (Attach agreement copy); and b) Name and address of the Owner of the Aerodrome Site 5. DETAILS OF THE AERODROME Operating Hours Largest Type of aircraft expected to operate at aerodrome Aerodrome reference code Type of Runway/Landing Strip (Non –Instrument/Non-Precision/Precision CAT-I/Precision CAT-II/Precision CAT-III) GACA-AVSES-AGA-F003 Rev: 6, Date: 25 Mar 25 Page 1 of 2 GACA الهييه العامه للطيران المدني General Authority of Civil Aviation [Non-Text] APPLICATION FORM FOR AERODROME CERTIFICATION OR AUTHORIZATION 6. CLASSIFICATION OF AERODROME (Type of Use)? Please tick mark (√) one of the boxes □ Civil/Public □ General Aviation If General Aviation: Private Aerodrome/ Flight Training Aerodrome/ General Purpose Aerodrome 7. DETAILS TO BE SHOWN ON THE AERODROME CERTIFICATE Name of Aerodrome Name of Aerodrome Operator Aerodrome ICAO/KSA Code On behalf of the applicant/aerodrome operator, I certify that all above information is correct to best of my knowledge and I hereby apply in the prescribed forms for the issuance of an Aerodrome Certificate/Authorization to operate the Aerodrome. Applicant/Accountable Executive Name Position/Title Date Signature 1. The following documents must be attached with this application form: a) Statement of Regulation Compliances (Form: ASD-139-1631). b) List of Regulation Non-Compliances (Form: ASD-139-1632), if applicable. c) Nomination form of Aerodrome Management Personnel (Form: ASD-139-1633) d) Aerodrome Manual. e) Safety Management System (SMS) Manual. f) Aerodrome Emergency Plan (AEP) Manual. g) Security Program Manual (SPM); and h) Any other relevant documents, if any GACA-AVSES-AGA-F003 Rev: 6, Date: 25 Mar 25 Page 2 of 2