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Fit and Proper Person Declaration

Instructions for completing this form


1. This declaration must be accompanied by an application form or letter - do not send in separately
2. It may only be used by applicants who have been determined Fit and Proper previously and:
• within the past 24 months who have completed a Fit and Proper Person Questionnaire (CAA 24FPP), and
• where the facts and information declared previously are unchanged.

1. Personal Details
NZ CAA Client / Licence Number Date of Birth (dd/mm/yy)

Title (Mr/Mrs/Ms/Miss) Last Name

Given Name(s)

Country of Birth Nationality

2. Declaration
Complete details of CAA
24FPP Questionnaire I, (name) ,
completion within
previous 24 months. declare that I have previously submitted a CAA 24FPP form on (date) ,

The provision of false for the purpose of (document / licence applied for) ,
information or failure to and that the information so presented, including any enclosures, is unchanged and reflects my record of
disclose information conduct.
relevant to the grant or Consent to Disclosure and Collection
holding of an aviation
I authorise the collection by the Director of Civil Aviation or his delegate (hereinafter referred to as "the
document constitutes an Director") from, and the disclosure to the Director by, any person, organisation or government department
offence under Section 49 of any details of the following information about me: my knowledge and compliance with transport safety
of the Civil Aviation Act regulatory requirements; my physical or mental health or serious behavioural problems; any
1990 and is subject, in criminal investigations, charges or convictions, including any matters relating to any transport safety
the case of an individual, offence. However I do not consent to the release of any information to which the clean slate scheme
applies, pursuant to the Criminal Records (Clean Slate) Act 2004.
to imprisonment for a
term not exceeding 12 I authorise the Director to use, and disclose, the information obtained about me for any purpose
months or to a fine not associated with the lawful functions of the Director and the Civil Aviation Authority under the Civil Aviation
exceeding $10,000. Act 1990, or other such purpose permitted by law.
Applicant’s Date
Signature

Attach this declaration to the relevant application form and post to:
Civil Aviation Authority, P O Box 31-441, Lower Hutt, 5040, New Zealand

CAA USE ONLY


Assessment

Fit and Proper Person: Yes No

Name: Signature:
Position: Date:

Page 1 of 1 CAA 24FPPDEC


Rev 2 : Feb 10