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EASA Form

PART-66 A
APPLICAT

Please comple


1. APPLI

DCA Part-66 A

Surname
Date of birth (d
Nationality
Permanent ad

Address for co

Telephone Nu
Email address
Name and add

Maintenance O
Telephone Nu


2. APPLI

APPLICATION
Initial Issue
Type rating
Removal of lim
Renewal

In Rating:

Aeroplane Tu
Aeroplane Pis
Helicopter Tur
Helicopter Pis
Avionics
Piston Engine
of 2000kg and
Large Aircraft
Aircraft other t







Cyprus D
19
AIRCRAFT M
TION
ete the form in B
CANTS DETA
AML number (if
dd/mm/yyyy)

ddress
orrespondence
umber
s
dress of Employ
Organisation Ap
umber
CATION
N FOR: (tick bo
mitation (Type)
rbine
ston
rbine
ston
e Non-Pressuris
d below
than large aircra
Department
MAINTENAN
BLOCK CAPITA
AILS
known)

(if different from
yer
pproval Ref.
oxes)
sed aeroplanes
aft
t of Civil Av


NCE ENGINE
ALS using black


m above)


of MTOM



viation
V3JUL20
EERS LICEN
k or dark blue in
Licens
First n
Place

Postc
Postc
Fax N

Postc
Fax N
Remova
Inclusio
Change

A

12
NSE INITIAL
k
se Date of Issue
name(s)
of Birth
ode
ode
Number
ode
No.
al of limitation(s
on of another ca
e of Applicants
B1

L / VARIATIO
e
s) (Basic)
ategory
Details
B2
N/A
N/A
N/A
N/A



ON / RENEW
B3





Page 1

WAL

C
N/A
N/A
N/A
N/A
N/A

1 of 6
Print Form
EASA Form 19 V3JUL2012 Page 2 of 6





3. CREDITS CLAIM (refer to Note 3 of the Guidance Document)

I wish to claim the following credits (applicable to basic category only):

Experience credit due Part 147 training (details of Part-147 organisation attended):






Examination credit due equivalent exam certificates exam accredited and recognized by DCA based on Examination Credit
Report DCA Ref. No .





Experience due to a skilled worker (see Part-66.A.30):





Please enclose all relevant certificates


4. SUMMARY OF EXPERIENCE (not required for Part-66 renewal) (refer to Note 4 of the Guidance Document)
Dates
Aircraft
Engine(s) and/or
Equipment
Description of experience
Details of experience should include the category of such
experience i.e. A, B1, B2, B3 or C
From To








5. EXAMINATION MODULES COMPLETED (refer to Note 5 of the Guidance Document)
Module Exam

Module Exam

1 Mathematics

10 Aviation Legislation

2 Physics

11
Aeroplane Aerodynamics, Structures &
Systems
3 Electrical Fundamentals

12
Helicopter Aerodynamics, Structures &
Systems
4 Electronic Fundamentals

13 Aircraft Aerodynamics, Structures & Systems

5
Digital Techniques/Electronic Instrument
Systems
14 Propulsion

6 Materials & Hardware

15 Gas Turbine Engine

7 Maintenance Practices

16 Piston Engine

8 Basic Aerodynamics

17 Propeller

9 Human Factors




EASA Form 19 V3JUL2012 Page 3 of 6



6. REMOVAL OF LIMITATIONS FROM BASIC LICENSE (refer to Note 6 of the Guidance Document)
Limitations List Examinations Completed







7. TYPE RATING APPLICATION(S) or REMOVAL OF LIMITATIONS ( tick applicable box)

New Type Group (refer to Note 7 of the Guidance Document)

Aircraft type/Series/Group Engine Category
Course Completion Certificate /or
Proof of experience enclosed
B1 B2 B3 C Yes No








8. LIST OF ALL RELEVANT CERTIFICATES ENCLOSED WITH THIS APPLICATION
(refer to Note 2 of the Guidance Document)





















9. DECLARATION (refer to Note 8 of the Guidance Document)

I wish to apply for initial/amendment/renewal of Part-66 AML as indicated and confirm that the information contained in this form was
correct at the time of application. I herewith confirm that:

1. I am not holding any Part 66 AML issued in another Member State.
2. I have not applied for any Part 66 AML in another Member State and
3. I never had a Part 66 AML issued in another Member State which was revoked or suspended in any other Member State.

I also understand that any incorrect information could disqualify me from holding a Part 66 AML.

Signature Date









EASA Form 19 V3JUL2012 Page 4 of 6


10. RECOMMENDATION (not required for Part-66 renewal - to be completed by Part-145 Maintenance Organisation if
authorized by DCA - refer to Note 9 of the Guidance Document)

It is hereby certified that the applicant has met the relevant maintenance knowledge and experience requirements of Part-66 and is
recommended that the competent authority grants or endorses the Part-66 AML.


Name

Signature



Position


Date




11. PAYMENT METHOD & SUBMISSION INSTRUCTIONS

Complete Payment Form LICACC 01

Please refer to Departments official webpage for application form and details of fees required. Once your application is completed, your
application should be posted along with the required documentation to:
Cyprus Department of Civil Aviation, Safety Regulation Unit, Licensing Section, 27 Pindarou str., 1429 Nicosia, Cyprus.

Please note that failure to submit all required documentation will result in the return of your application.

EASA Form


PART-66 A
APPLICAT

General Gu

Note 1: Whi


Initial Part-66
Inclusion of an
Type Ratings
Removal of Li
Removal of Li
Change of Ap
Renewal

Note 2: The

See Applicat
the relevant
certified as T



Application f
Initial Issue
Inclusion of a
Type Rating
Removal of L
Removal of L
Change of A
Renewal

Cyprus D
19
AIRCRAFT M
TION
idance on ho
ich Sections
License Issue (
nother Category
mitations from B
mitations from T
plicants Details
supporting d
tion checklist,
fees must be
True Copies
for:
another Categ
Limitation (Typ
Limitation (Ba
Applicants det
Department
MAINTENAN
ow to complet
of the applica
Appli
(Part-147 studen
y
Basic License
Type Ratings
s
documentatio
which should
e submitted wi
by the Quality
gory
pe)
sic)
tails
t of Civil Av


NCE ENGINE
GUIDAN
te the Part
ation form to
ication
nt and other exp
on required w
d be used as a
th your applic
y Manager of
viation
V3JUL20
EERS LICEN
NCE DOCUM


66 license ap
o complete
perienced engin
with applicatio
a final check o
cation. All cert
Part-145 or P
12
NSE INITIAL
MENT
pplication for
neers)
on
once your app
tificates must
Part-147 organ
L / VARIATIO
m
Section
1,2,3,4,5,8
1,2,3,4,5,8
1,2,4,7,8,9
1,2,4,5,6,8
1,2,4,7,8,9
1,2,8,9
1,2,8,9
plication is rea
be either Ori
nisation.

ON / RENEW
to be comple
,9,10
,9,10
,10
,9,10
,10
ady to be subm
ginal or copi
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r
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EASA Form 19 V3JUL2012 Page 6 of 6





Note 3: Section 3 - Credits Claim

This section is required if the applicant is to claim:

(a) A reduction in experience requirements if an Approved Part-147 Basic Training Course was completed or

(b) An exemption from a basic Part-66 examination based on an exam or technical qualification that was accredited and
accepted by DCA through an Examination Credit Report.

Note 4: Section 4 - Summary of Experience

This section must provide information relating directly to your application. For example, if you are applying for a removal of
limitation(s) from a type rating, only information relating to that type and limitation is required. In addition, it is only necessary
to provide information on duration of experience relating to whichever license and/or rating you are applying for.

Note 5: Section 5 - Examination Modules Completed

This section requires a tick in the appropriate box to confirm your examination module passes. In the cases of removing
limitations or extending the license privileges to include another Category license, you should tick only the additional modules
required for the particular case.

Note 6: Section 6 - Removal of Limitations from a Basic License

To remove limitations from a basic license, the relevant examinations must be passed and any appropriate experience
requirements met. Application to remove limitations on a basic Category/sub-category must cover all limitations applicable to
that Category/sub-category, as the Part-66 license is not considered to be a progressive license.

Note 7: Section 7 - Type Rating Application/ Removal of Limitation

This section should be used if applying for an additional type rating or Group rating or a removal of a limitation from a type
rating, and should detail aircraft types by airframe/engine combination. A tick should be placed in the appropriate Category
license for which the type rating or removal of limitation is required.
The application should be supported by the demonstration of appropriate experience or practical assessment and for the
case of limitations related to conversion of grandfather rights, with the documents required by the applicable conversion
report.

Note 8: Section 9 - Declaration

This section must be completed by the applicant after reviewing all information entered on the application form.

Note 9: Section 10 - Recommendation

The referee required to countersign the form must be a Quality Manager or a senior person within the Quality Department of
your current employer.
This section should be completed by a Part-145 Maintenance Organisation if authorized by DCA to prepare and make
recommendations to the authority regarding the application from an individual for an aircraft maintenance license.

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