019 - air-operators-special-operations-approvals -and -authorizations-application-form

gaca_gov_sa · form · processed · 4 chunks
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
العربيه العاميه للطيران المدني
General Authority of Civil Aviation
AIR OPERATORS – SPECIAL OPERATIONS APPROVALS /AUTHORIZATIONS
APPLICATION FORM
SECTION A - ORGANIZATION
<table><tr><td colspan="3">1. Organization Details</td></tr><tr><td>a.</td><td colspan="2">Company Details</td></tr><tr><td>1</td><td>Registered Name</td><td></td></tr><tr><td>2</td><td>Trading name if different</td><td></td></tr><tr><td>3</td><td>Mailing address</td><td></td></tr><tr><td>4</td><td>Contact Number</td><td></td></tr><tr><td>5</td><td>E-mail</td><td></td></tr><tr><td>6</td><td>Trading name if different</td><td></td></tr></table>
<table><tr><td>b.</td><td colspan="2">Principal Place of Business</td></tr><tr><td>1</td><td>Mailing address</td><td></td></tr><tr><td>2</td><td>Contact Number</td><td></td></tr><tr><td>3</td><td>E-mail</td><td></td></tr></table>
<table><tr><td>c.</td><td>Proposed Starting Date</td><td></td></tr></table>
<table><tr><td>d.</td><td>Air Operator Focal Point Position</td><td></td></tr><tr><td colspan="2">Focal Point Name</td><td>Contact No. E-mail</td></tr><tr><td colspan="2"></td><td></td></tr></table>
<table><tr><td colspan="5">2. Approved Management Details</td></tr><tr><td>No.</td><td>Title</td><td>Name</td><td>Contact No.</td><td>E-mail</td></tr><tr><td>a.</td><td>Accountable Executive (CEO)</td><td></td><td></td><td></td></tr><tr><td>b.</td><td>Flight Operations post holder (DFO)</td><td></td><td></td><td></td></tr><tr><td>c.</td><td>Chief Pilots</td><td></td><td></td><td></td></tr><tr><td>d.</td><td>Maintenance post holder (DOM)</td><td></td><td></td><td></td></tr><tr><td>e.</td><td>Chief inspector</td><td></td><td></td><td></td></tr><tr><td>f.</td><td>Safety Management System Manager</td><td></td><td></td><td></td></tr><tr><td>g.</td><td>Quality System Manager</td><td></td><td></td><td></td></tr><tr><td>h.</td><td>Ground operations post holder, if applicable</td><td></td><td></td><td></td></tr><tr><td>i.</td><td>Security Manager, if applicable</td><td></td><td></td><td></td></tr></table>
SECTION B – OPERATIONS
<table><tr><td colspan="7">1. Approved Type of Operations</td></tr><tr><td>a</td><td>Applicable GACAR</td><td>□ 91 □ 121</td><td>□ 135 □ 125</td><td>□ 133</td><td></td><td></td></tr><tr><td colspan="2">□ Scheduled</td><td>□ Non-Scheduled</td><td colspan="2">□ Passengers</td><td>□ Cargo</td><td></td></tr><tr><td colspan="3">□ Passenger &amp; Cargo – Passengers Aircraft</td><td colspan="4">□ Passengers &amp; Cargo – Cargo Aircraft</td></tr></table>
2. Approved Airplane Type
<table><tr><td>No.</td><td>Aircraft Type</td><td>Model</td><td>Registration Mark</td><td>Build Date (dd/mm/yy)</td><td>Number of Passengers Seats</td><td>Cargo Payload</td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></table>
GACA-AVSES-OPS-F019
Rev: 3, Date: 15 Jul 25
Page 1 of 3

GACA
الهييه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
AIR OPERATORS – SPECIAL OPERATIONS APPROVALS /AUTHORIZATIONS
APPLICATION FORM
<table><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>,</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></table>
<table><tr><td colspan="4">3. Approved Area of Operations (Enter coordinate of the area or national/FIR boundaries)</td></tr><tr><td>a.</td><td>□ Proposed/approved route (s), if applicable</td><td>Attach a list</td><td></td></tr><tr><td>b.</td><td>□ Destination(s) and alternate aerodromes, if applicable</td><td>Attach a list</td><td></td></tr></table>
<table><tr><td colspan="2">4. Special Approvals/Authorizations requested</td></tr><tr><td>a.</td><td>□ Steep Approach</td></tr><tr><td>b.</td><td>□ Performance based navigation (PBN)</td></tr><tr><td>c.</td><td>□ Reduced vertical separation minimum (RVSM)</td></tr><tr><td>d.</td><td>□ Low visibility take-off (LVTO)</td></tr><tr><td>e.</td><td>□ Non-Precision, APV and Category I</td></tr><tr><td>f.</td><td>□ Standard CAT II operations</td></tr><tr><td>g.</td><td>□ Standard CAT III A operations</td></tr><tr><td>h.</td><td>□ Standard CAT III B operations</td></tr><tr><td>i.</td><td>□ Extended range operation twin engine airplanes (ETOPS)</td></tr><tr><td>j.</td><td>□ Electronic Flight Bag (EFB)</td></tr><tr><td>k.</td><td>□ Minimum navigation performance specification (MNPS)/NAT High Level Airspace (NAT HLA)</td></tr><tr><td>l.</td><td>□ Use of Enhanced Vision Systems</td></tr></table>
<table><tr><td colspan="5">5. Aircraft Navigation Capabilities</td></tr><tr><td>NO.</td><td>Aircraft Type</td><td>PBN</td><td>RVSM</td><td>MNPS</td></tr><tr><td>a.</td><td></td><td></td><td></td><td></td></tr><tr><td>b.</td><td></td><td></td><td></td><td></td></tr><tr><td>c.</td><td></td><td></td><td></td><td></td></tr><tr><td>d.</td><td></td><td></td><td></td><td></td></tr><tr><td>e.</td><td></td><td></td><td></td><td></td></tr><tr><td>f.</td><td></td><td></td><td></td><td></td></tr><tr><td>g.</td><td></td><td></td><td></td><td></td></tr><tr><td>h.</td><td></td><td></td><td></td><td></td></tr><tr><td>i.</td><td></td><td></td><td></td><td></td></tr><tr><td>j.</td><td></td><td></td><td></td><td></td></tr><tr><td>k.</td><td></td><td></td><td></td><td></td></tr></table>
SECTION C – ACCOUNTABLE MANAGER/EXECUTIVE DECLARATION
<table><tr><td colspan="4">The undersigned certify that statements and answers provided in this application form and attachments are complete and true to the best of my knowledge and agree that they are to be considered as part of the basis for issuance of the requested approval/authorization in accordance with GACAR(s) (XXX) and eBook V5.</td></tr><tr><td>Name</td><td>Signature</td><td>Date</td><td></td></tr><tr><td></td><td></td><td></td><td></td></tr></table>
GACA-AVSES-OPS-F019
Rev: 3, Date: 15 Jul 25
Page 2 of 3

GACA
ال necesita للطيران المدني
General Authority of Civil Aviation
[Non-Text]
AIR OPERATORS – SPECIAL OPERATIONS APPROVALS /AUTHORIZATIONS
APPLICATION FORM
SECTION D – FOR GACA USE ONLY
<table><tr><td colspan="5">1. Operational Approval Details</td></tr><tr><td colspan="5">• Special Approval(s)/Authorization(s) Request Status</td></tr><tr><td>No.</td><td>Special Approval(s)/Authorization(s) Request</td><td>Accepted</td><td>Rejected</td><td>Remarks</td></tr><tr><td>a</td><td>□ Steep Approach</td><td>□</td><td>□</td><td></td></tr><tr><td>b</td><td>□ Performance based navigation (PBN)</td><td>□</td><td>□</td><td></td></tr><tr><td>c</td><td>□ Reduced vertical separation minimum (RVSM)</td><td>□</td><td>□</td><td></td></tr><tr><td>d</td><td>□ Low visibility take-off (LVTO)</td><td>□</td><td>□</td><td></td></tr><tr><td>e</td><td>□ Non-Precision, APV and Category I</td><td>□</td><td>□</td><td></td></tr><tr><td>f</td><td>□ Standard CAT II operations</td><td>□</td><td>□</td><td></td></tr><tr><td>g</td><td>□ Standard CAT III A operations</td><td>□</td><td>□</td><td></td></tr><tr><td>h</td><td>□ Standard CAT III B operations</td><td>□</td><td>□</td><td></td></tr><tr><td>i</td><td>□ Extended range operation twin engine airplanes (ETOPS)</td><td>□</td><td>□</td><td></td></tr><tr><td>j</td><td>□ Electronic Flight Bag (EFB)</td><td>□</td><td>□</td><td></td></tr><tr><td>k</td><td>□ Minimum navigation performance specification (MNPS)/NAT High Level Airspace (NAT HLA)</td><td>□</td><td>□</td><td></td></tr><tr><td>l</td><td>□ Use of Enhanced Vision Systems</td><td>□</td><td>□</td><td></td></tr></table>
<table><tr><td colspan="5">2. Limitations (if applicable)</td></tr><tr><td>No.</td><td colspan="3">Limitations</td><td>GACARs/ eBook V Ref.</td></tr><tr><td></td><td colspan="3"></td><td></td></tr><tr><td></td><td colspan="3"></td><td></td></tr><tr><td></td><td colspan="3"></td><td></td></tr><tr><td></td><td colspan="3">-</td><td></td></tr><tr><td></td><td colspan="3"></td><td></td></tr><tr><td></td><td colspan="3"></td><td></td></tr><tr><td></td><td colspan="2"></td><td></td><td></td></tr><tr><td></td><td colspan="2"></td><td></td><td></td></tr><tr><td></td><td colspan="2"></td><td></td><td></td></tr><tr><td>ASI Name</td><td colspan="2">Signature</td><td>Date</td><td></td></tr><tr><td></td><td colspan="2"></td><td></td><td></td></tr></table>
SECTION E. REQUIRED SUPPORTING DOCUMENTS AND EVIDENCES
Refer to the applicable Operational Approval attachment(s)
1. Operational Approval Application Attachments and Supporting Documents
1. An official Organization's cover letter;
2. This application Form; and
3. Operational approval Application Form Attachment(s) – Operational approval/authorization requirements in accordance with the applicable GACARs and eBook V5;
4. Copy of related Training record/completion letter for Pilots;
5. Other personnel training, as applicable;
6. Evidence(s) for the Operational Approvals/Authorizations requirements in accordance with the applicable GACAR(s), eBook V5 and any other GACA requirements;
7. Provide the amended parts of the applicable Organization's manual (e.g. OM, AFM, etc.), check the related attachment(s);
8. Copy of the related Training record/completion letter for Pilots;
9. Airworthiness Standards Formal Application Form & Attachments – Airworthiness Approval/Authorization
10. Financial data and a business plan, if applicable
GACA-AVSES-OPS-F019
Rev: 3, Date: 15 Jul 25
Page 3 of 3