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GACA الطبيه العامه للطيران المدني General Authority of Civil Aviation [Non-Text] APPLICATION FOR AIRCRAFT REGISTRATION <table><tr><td>□</td><td>INITIAL REGISTRATION</td><td>□</td><td>DE-REGISTRATION</td><td>□</td><td>CHANGING OF OWNERSHIP</td><td rowspan="2">HZ-</td><td></td></tr><tr><td>□</td><td colspan="2">CHANGING REGISTRATION MARK</td><td>□</td><td>OTHER</td><td></td><td></td></tr></table> <table><tr><td rowspan="4">OWNER</td><td>Organization</td><td colspan="3"></td></tr><tr><td>Name</td><td colspan="3"></td></tr><tr><td>Address</td><td colspan="3"></td></tr><tr><td>Tel. No.</td><td></td><td>Mobile No.</td><td>Email</td></tr></table> <table><tr><td rowspan="4">OPERATOR</td><td>Organization</td><td colspan="3"></td></tr><tr><td>Name</td><td colspan="3"></td></tr><tr><td>Address</td><td colspan="3"></td></tr><tr><td colspan="4">Tel. No. Mobile No. Email</td></tr></table> <table><tr><td rowspan="7">AIRCRAFT</td><td>Make and Model</td><td colspan="2"></td><td>Serial No</td><td></td></tr><tr><td>Manufacture</td><td colspan="2"></td><td>Year Manufactured</td><td></td></tr><tr><td>Category / Class</td><td></td><td>MAX. Gross WT</td><td colspan="2">(KG) Type Certificate</td></tr><tr><td>Data Sheet No.</td><td colspan="4"></td></tr><tr><td>Previous Foreign Registration</td><td></td><td colspan="2">Date of De-Registration</td><td></td></tr><tr><td>Previous Saudi Registration (if applicable)</td><td colspan="4">HZ-</td></tr><tr><td>Previous Saudi Owner (if applicable)</td><td colspan="4"></td></tr><tr><td></td><td>Registration Mark Requested by Applicant</td><td colspan="2">HZ-</td><td colspan="2">(Subject for Availability)</td></tr></table> <table><tr><td colspan="3">I hereby certify that the above aircraft is not registered under the law of any foreign country and the above statements are correct and true to the best of my knowledge. I will return the expired certificate of registration within two (2) weeks.</td></tr><tr><td>Signature of Owner</td><td>Date</td><td>Official Seal</td></tr><tr><td></td><td></td><td></td></tr><tr><td colspan="3">NOTE: The aircraft described above may be operated, pending registration or notification from the General Authority of Civil Aviation provided airworthiness requirements of applicable regulation are compiled with.</td></tr></table> GACA ACTION <table><tr><td>Aircraft Deregistered from Country of Origin (if applicable)</td><td>☐ Date</td><td></td></tr><tr><td>Registration Mark Assigned by GACA</td><td>HZ-</td><td></td></tr></table> <table><tr><td>Issued by</td><td>Date</td><td>Signature</td></tr><tr><td></td><td></td><td></td></tr><tr><td>Received by</td><td>Date</td><td>Signature</td></tr><tr><td></td><td></td><td></td></tr></table> GACA-AVSES-AIR-F047 Rev: 6, Date: 29 May 25 Page 1 of 1