gaca_gov_sa · form · processed · 2 chunks
GACA الحييه العامه لطيران المدني General Authority of Civil Aviation [Non-Text] APPLICATION FORM FOR WATER AERODROME CERTIFICATION OR AUTHORIZATION (GACAR PART 137) INSTRUCTIONS A. This form is to be filled in by the Applicant/Owner/Water Aerodrome Operator for the issuance of Water Aerodrome Certificate or Authorization as per provisions in GACAR Part 137. B. No part must be left blank. Write “Not Applicable”, if the information to be filled does not pertain to the water aerodrome. C. For clarification contact the General Manager (Aerodrome Safety Department) of General Authority of Civil Aviation, Kingdom of Saudi Arabia. 1. PARTICULARS OF THE REQUIREMENTS OF WATER AERODROME Please check mark (X) one of the box applicable to the requirement of Applicant/Water Aerodrome Operator Initial Certification Renewal Certification Initial Authorization Renewal Authorization 2. PARTICULARS OF THE APPLICANT/WATER AERODROME OPERATOR Full Name Position/Title Address Phone Email Mobile Fax 3. LOCATION DETAILS OF THE WATER AERODROME Name of Water Aerodrome Identification Code of Water Aerodrome Geographical Coordinates of the Water Aerodrome Reference Point (WGS-84 format) Longitude " N Latitude ° ' " E 4. IS THE APPLICANT/WATER AERODROME OPERATOR THE OWNER OF WATER AERODROME? Please check mark (X) one of the applicable boxes □ Yes □ No If No, Provide; Details of Rights Held/Lease Deed in Relation to the Water Aerodrome (Attach copy of the agreement/Lease); and Name and address of the Owner of the Water Aerodrome 5. TECHNICAL DETAILS OF THE WATER AERODROME Please fill in all required information Water Aerodrome Reference Code Largest type of seaplane expected to operate at Water Aerodrome Operating Hours Nos and Orientation of Water Runways Category of Water Aerodrome RFF Type of Runway. Please tick mark (√) one applicable □ Non-Instrument □ Non-Precision □ Precision GACA-AVSES-AGA-F006 Rev: 7, Date: 24 Aug 25 Page 1 of 2 GACA ال necesita العامه للطيران المدني General Authority of Civil Aviation [Non-Text] APPLICATION FORM FOR WATER AERODROME CERTIFICATION OR AUTHORIZATION (GACAR PART 137) 6. CLASSIFICATION OF WATER AERODROME (Reference GACAR Part 137.105) Please tick mark (√) one of the boxes <table><tr><td>□</td><td>Civil/Public Water Aerodrome</td><td>□</td><td>General Aviation Water Aerodrome</td></tr><tr><td colspan="4">If General Aviation Water Aerodrome, please tick mark (√) one applicable:</td></tr><tr><td>□</td><td>Private Water Aerodrome</td><td>□</td><td>Flight Training Water Aerodrome □ General Purpose Water Aerodrome</td></tr></table> 7. DETAILS TO BE SHOWN ON THE WATER AERODROME CERTIFICATE <table><tr><td>Name of Water Aerodrome</td><td></td></tr><tr><td>Name of Water Aerodrome Operator</td><td></td></tr><tr><td>Water Aerodrome ICAO/KSA Code</td><td></td></tr></table> <table><tr><td colspan="2">On behalf of the applicant/water aerodrome operator, I certify that all the above information is correct to the best of my knowledge and I hereby apply in the prescribed forms for the issuance of a Water Aerodrome Certificate or Authorization to operate the water aerodrome as per the provisions prescribed in GACAR Part 137.</td></tr><tr><td>Signature of the Accountable Executive</td><td>Name</td></tr><tr><td></td><td></td></tr><tr><td>Position held</td><td>Date</td></tr><tr><td></td><td></td></tr></table> (Note: This application form must be attached with all the required documents as prescribed in GACAR Part 137.127 for certification or GACAR Part 137.147 for authorization, as applicable. Incomplete form or false information or non-submission of required documents will make the application liable for rejection.) GACA-AVSES-AGA-F006 Rev: 7, Date: 24 Aug 25 Page 2 of 2