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    Form DGCA 61-01B William

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    William Martinus
    The document is an application from William Martinus to the Directorate General of Civil Aviation of Indonesia to become a Flight Instructor Airplane. It contains information about the applicant such as his personal details, license and medical certificate information. It also includes sections for the applicant's certification, a POI recommendation, and a DGCA Inspector's report on evaluating the applicant's qualifications to become a Flight Instructor.

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    Form DGCA 61-01B William

    Uploaded by

    William Martinus
    130 views2 pages
    The document is an application from William Martinus to the Directorate General of Civil Aviation of Indonesia to become a Flight Instructor Airplane. It contains information about the applicant such as his personal details, license and medical certificate information. It also includes sections for the applicant's certification, a POI recommendation, and a DGCA Inspector's report on evaluating the applicant's qualifications to become a Flight Instructor.

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    The document is an application from William Martinus to the Directorate General of Civil Aviation of Indonesia to become a Flight Instructor Airplane. It contains information about the applicant such as his personal details, license and medical certificate information. It also includes sections for the applicant's certification, a POI recommendation, and a DGCA Inspector's report on evaluating the applicant's qualifications to become a Flight Instructor.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    130 views2 pages

    Form DGCA 61-01B William

    Uploaded by

    William Martinus
    The document is an application from William Martinus to the Directorate General of Civil Aviation of Indonesia to become a Flight Instructor Airplane. It contains information about the applicant such as his personal details, license and medical certificate information. It also includes sections for the applicant's certification, a POI recommendation, and a DGCA Inspector's report on evaluating the applicant's qualifications to become a Flight Instructor.

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    © All Rights Reserved
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    You are on page 1of 2

    MINISTRY OF TRANSPORTATION

    DIRECTORATE GENERAL OF CIVIL AVIATION


    Office Complex Soekarno-Hatta International Airport, C3 St., Tangerang, Banten- Indonesia
    Telp.: (+6221) 225 66288, (+6221) 256 08887 Fax. : (+6221) 225 66399
    Website : hubud.dephub.go.id; e-mail: [email protected]

    INSTRUCTOR / CHECKER FOR PILOT, FOO, FE, AND FA APPLICATION

    I. Application information
    [ ] Ground Instructor [ ] Flight Instructor Instrument [ ] CCP Line Check All Seat [ ] Company Checker
    [ ] Flight Instructor Simulator [ ] CCP Prof Check on Simulator [ ] CCP Observer Only [ ] Initial / Renewal
    [X ] Flight Instructor Airplane [ ] CCP Prof Check on Aircraft [ ] Company Instructor [ ] Others : ___________________

    A. Name (Full) B. KTP/Passport C. Date of Birth D. Place of Birth (City, Country)

    William Martinus 3674011802 DD/MM/YYYY


    940005 18/02/1994 Jakarta, Indonesia
    E. Address (KTP/Passport) F. Nationality Specify G. Do you read, speak and understand
    English?
    Jl Kalimantan IX, F1/2
    [X] Indonesian [ ] Other ___________
    Sektor 14 BSD City [ X] Yes [ ] No
    Tangerang Selatan, Banten
    H. Height (cm) I. Weight (kg) J. Sex
    183 93 MALE
    L. License / Certificate No. M. Date Issued
    ATPL 18-0066 17/05/2018

    N. Do you hold a [X] Yes O. Class of Certificate P. Date Issued Q. Name of Examiner
    Medical Certificate? [ ] No dr. Kartini Utami N., FS
    First Class 14/09/2020
    R. Have you ever been convicted for violation of any laws pertaining to S. Date of Final Conviction
    Narcotic drugs, marijuana, and depressant or stimulant drugs or substances, or motor [X] No
    Vehicle operation involving alcohol related offenses? [ ] Yes

    II. Applicant’s Certification: A. Name & Signature B. Date (DD/MM/YYYY)


    I certify that the statements made by me on this application are true.

    21/02/2021
    William Martinus

    DGCA Form No. 61-01B (Oct 2017) Page 1 of 2


    POI Recommendation:
    I have personally instructed the applicant and consider this person ready to take the test

    Date (DD/MM/YYYY) POI Name & Signature

    [ ] I have personally renewed this applicant’s Training Record and Approved Training Program Manual certify that the individual meets the pertinent requirements of all applicable
    requirements.

    DGCA Inspector’s Report


    Evaluator’s record
    Inspector Examiner Name & Signature Date of Completion
    Oral and Demonstrate Presentation [ ] [ ] ________________________________ _____________________
    Approved Simulator/Training Device Check [ ] [ ] ________________________________ _____________________
    Aircraft flight check [ ] [ ] ________________________________ _____________________

    I have personally tested this applicant in accordance with or have otherwise verified that this applicant complies with pertinent procedures, standards, polices and or necessary requirements
    with the result indicated below:
    [ ] Approved [ ] Disapproved – Disapproval Notice Issued

    Location of test (Facility, City, Country) Duration of Test (hours)


    Ground : Simulator /Training Device : Flight :

    Aircraft Rating for which tested Type(s) of aircraft used for test Aircraft Registration No.(s) used for test

    Date (DD/MM/YYYY) Inspector’s Name & Signature DGCA Office

    DGCA Form No. 61-01B (Oct 2017) Page 2 of 2

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