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GACA ال necesita للطيران المدني General Authority of Civil Aviation [Non-Text] FSTDS QUALIFICATION RENEWAL/ADDITIONAL/RELOCATION APPLICATION FORM Note: For Continuing qualification evaluation. “The sponsor must contact the President to schedule the FSTD for continuing qualification evaluations not later than 60 days before the evaluation is due.” (GACAR PART-60). <table><tr><td colspan="5">1. FSTD OPERATOR DETAILS</td></tr><tr><td>Training Organization/Operator Name</td><td colspan="4"></td></tr><tr><td>Organization Certificate Name</td><td colspan="4"></td></tr><tr><td>Organization Address</td><td colspan="4"></td></tr><tr><td>Contact Manager details</td><td>Name</td><td>Position</td><td>Contact Number</td><td>Email</td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr></table> <table><tr><td colspan="5">2. PURPOSE OF APPLICATION</td></tr><tr><td colspan="5">The required evaluation for the mentioned Flight Synthetic Training Device(s) Qualification in accordance with GACAR PART 60 – FSTD for:</td></tr><tr><td>□ Renewal</td><td>□ Additional</td><td>□ Modification</td><td colspan="2">□ Relocation</td></tr><tr><td>Requested Date</td><td></td><td></td><td colspan="2"></td></tr></table> <table><tr><td colspan="5">3. FSTD TYPE DETAILS</td></tr><tr><td>FSTD for Aircraft Category</td><td colspan="2">□ Airplane</td><td colspan="2">□ Helicopter</td></tr><tr><td>Type of FSTD Aircraft (A/H)</td><td>Aircraft Type/Class</td><td colspan="3">Qualification Level</td></tr><tr><td>Flight Simulator (FFS)</td><td></td><td>□ A</td><td>□ B</td><td>□ C □ D</td></tr><tr><td>Flight Training Device (FTD)</td><td></td><td>□ 1 □ 2</td><td>□ 3 □ 4 □ 5 □ 6 □ 7</td><td></td></tr><tr><td>Advanced Aviation Training Device (AATD)</td><td></td><td colspan="3"></td></tr><tr><td>Aviation Training Device (ATD)</td><td></td><td colspan="3"></td></tr><tr><td>Basic Aviation Training Device (BATD).</td><td></td><td></td><td></td><td></td></tr><tr><td>Flight and Navigation Procedure Trainer (FNPT)</td><td></td><td colspan="2">□ I □ II □ II MCC</td><td></td></tr></table> <table><tr><td colspan="2">4. FSTD TECHNICAL DETAILS</td></tr><tr><td>FSTD qualification number</td><td></td></tr><tr><td>Qualification Expiry date</td><td></td></tr><tr><td>FSTD Manufacturer Name and Serial No.</td><td></td></tr><tr><td>Visual System, if applicable</td><td></td></tr><tr><td>Primary Reference Document</td><td></td></tr></table> <table><tr><td colspan="2">5. VISUAL DATA BASES DETAILS (If applicable)</td></tr><tr><td>No.</td><td>Aerodrome Visual ground segment runway</td></tr><tr><td>a.</td><td></td></tr><tr><td>b.</td><td></td></tr><tr><td>c.</td><td></td></tr><tr><td>d.</td><td></td></tr></table> <table><tr><td colspan="3">6. QUALIFICATION TEST GUIDE DETAIL.</td></tr><tr><td>a.</td><td>Number of QTG's run in last year (If All, state “ALL”)</td><td></td></tr><tr><td>b.</td><td>Number of marginal results. (QTG)</td><td></td></tr><tr><td>c.</td><td>Number of failures. (QTG Number)</td><td></td></tr><tr><td>d.</td><td>Number of QTG's not run</td><td></td></tr></table> <table><tr><td colspan="3">7. MANUALS AND DOCUMENTATION (Current Issue)</td></tr><tr><td>Manual / Documentation</td><td>Current Issue/Revision No</td><td>Approved Date</td></tr><tr><td>Operations manual</td><td></td><td></td></tr><tr><td>Training manual</td><td></td><td></td></tr><tr><td>Quality manual</td><td></td><td></td></tr><tr><td>SMS manual, if applicable</td><td></td><td></td></tr></table> GACA-AVSES-OPS-F005 Rev: 3, Date: 15 May 25 Page 1 of 3 GACA الهييه العامه للطيران المدني General Authority of Civil Aviation [Non-Text] FSTDS QUALIFICATION RENEWAL/ADDITIONAL/RELOCATION APPLICATION FORM 8. QUALITY SYSTEM DETAILS <table><tr><td>Number of Scheduled Audits/Inspection per year</td><td></td></tr><tr><td>Audits completed / in progress</td><td></td></tr><tr><td>Scheduled Audits still to be commenced</td><td></td></tr></table> 9. ACCOUNTABLE MANGER/HEAD OF TRAINING DECLARATION. <table><tr><td colspan="2">● I certify that all the above information given is complete and correct</td></tr><tr><td>Name</td><td>Position Signature Date</td></tr><tr><td></td><td></td></tr></table> For GACA USE ONLY <table><tr><td colspan="10">1. FSTD QUALIFICATIONS EVALUATION/ASSESSMENT DETAILS</td></tr><tr><td colspan="4">Date</td><td colspan="2">FSTD for Aircraft Type/Class</td><td colspan="2">☐ Type Rating</td><td colspan="2">☐ Class Rating</td></tr><tr><td colspan="4">Duration of Flight Test Time</td><td colspan="2">Aircraft Type/Class</td><td rowspan="3" colspan="4"></td></tr><tr><td rowspan="3">FSTD Type</td><td colspan="2">☐ FFS</td><td colspan="2">☐ FTD</td><td rowspan="4" colspan="2">FSTD Level</td><td rowspan="3">☐ A</td><td rowspan="3">☐ B</td></tr><tr><td colspan="2">☐ AATD</td><td colspan="2">☐ ATD</td></tr><tr><td colspan="2">☐ FNPT</td><td colspan="2">☐ BATD</td></tr><tr><td>FSTD for Aircraft Category</td><td colspan="2">☐ Airplane</td><td colspan="2">☐ Helicopter</td><td>☐ 1</td><td>☐ 2</td><td>☐ 3</td><td>☐ 4</td><td>☐ 5</td></tr><tr><td>FSTD Documents</td><td colspan="2">☐ SAT</td><td colspan="2">☐ UNSAT</td><td colspan="2">☐ I</td><td colspan="2">☐ II</td><td colspan="2">☐ II MCC</td></tr></table> 2. REMARKS <table><tr><td>1</td><td></td></tr><tr><td>2</td><td></td></tr><tr><td>3</td><td></td></tr><tr><td>4</td><td></td></tr><tr><td>5</td><td></td></tr><tr><td>6</td><td></td></tr><tr><td>7</td><td></td></tr><tr><td>8</td><td></td></tr><tr><td>9</td><td></td></tr><tr><td>10</td><td></td></tr></table> 3. FSTD CERTIFICATION/APPROVAL STATUS <table><tr><td>FSTD Certification/Approval Status</td><td>□ Approved</td><td>□ Rejected</td></tr></table> 4. IF THE FSTD(S) CERTIFICATION/APPROVAL IS REJECTED, MENTION THE REASON(S) BELOW <table><tr><td>1</td><td></td><td></td></tr><tr><td>2</td><td></td><td></td></tr><tr><td>3</td><td></td><td></td></tr><tr><td>4</td><td></td><td></td></tr><tr><td>5</td><td></td><td></td></tr></table> GACA-AVSES-OPS-F005 Rev: 3, Date: 15 May 25 Page 2 of 3 GACA المنيه العامه للطيران المدني General Authority of Civil Aviation [Non-Text] FSTDS QUALIFICATION RENEWAL/ADDITIONAL/RELOCATION APPLICATION FORM <table><tr><td colspan="4">5. GACA CERTIFICATION/APPROVAL TEAM RECOMMENDATION(S)</td></tr><tr><td>1</td><td></td><td></td><td></td></tr><tr><td>2</td><td></td><td></td><td></td></tr><tr><td>3</td><td></td><td></td><td></td></tr><tr><td>4</td><td></td><td></td><td></td></tr><tr><td>5</td><td></td><td></td><td></td></tr><tr><td>6</td><td></td><td></td><td></td></tr><tr><td>7</td><td></td><td></td><td></td></tr><tr><td>8</td><td></td><td></td><td></td></tr><tr><td>9</td><td></td><td></td><td></td></tr><tr><td>10</td><td></td><td></td><td></td></tr></table> <table><tr><td colspan="5">6. GACA CERTIFICATION TEAM</td></tr><tr><td>No.</td><td>Air Safety inspector Name</td><td>Position</td><td>Date</td><td>Signature</td></tr><tr><td>1</td><td></td><td></td><td></td><td></td></tr><tr><td>2</td><td></td><td></td><td></td><td></td></tr><tr><td>3</td><td></td><td></td><td></td><td></td></tr><tr><td>4</td><td></td><td></td><td></td><td></td></tr><tr><td>5</td><td></td><td></td><td></td><td></td></tr></table> <table><tr><td>7. SUPPORTING DOCUMENTS</td></tr><tr><td>These application forms</td></tr><tr><td>The official request/letter for FSTD approval/certification</td></tr><tr><td>Copy of FSTD certificate/approval issued by GACA</td></tr><tr><td>Copy of Qualifications Specifications certificate/approval issued by GACA</td></tr><tr><td>Copy of valid Foreign FSTD certificate/approval and specification, if applicable</td></tr><tr><td>FSTD Qualification Evaluation checklist</td></tr><tr><td>Any other required document(s) requested by GACA</td></tr></table> GACA-AVSES-OPS-F005 Rev: 3, Date: 15 May 25 Page 3 of 3