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    Aeromania Single Pilot Exemption 11421 Application

    Uploaded by

    Paul Kostukovsky
    This document is an application for a Single Pilot Exemption. It collects personal information about the applicant such as name, address, pilot certificates held. It documents the applicant's flight experience, including total flight hours and hours in various aircraft. It also records any flight training received and the results of an evaluation. Required supporting documents are listed.

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    © All Rights Reserved
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    Aeromania Single Pilot Exemption 11421 Application

    Uploaded by

    Paul Kostukovsky
    32 views1 page
    This document is an application for a Single Pilot Exemption. It collects personal information about the applicant such as name, address, pilot certificates held. It documents the applicant's flight experience, including total flight hours and hours in various aircraft. It also records any flight training received and the results of an evaluation. Required supporting documents are listed.

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    © © All Rights Reserved

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    This document is an application for a Single Pilot Exemption. It collects personal information about the applicant such as name, address, pilot certificates held. It documents the applicant's flight experience, including total flight hours and hours in various aircraft. It also records any flight training received and the results of an evaluation. Required supporting documents are listed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    32 views1 page

    Aeromania Single Pilot Exemption 11421 Application

    Uploaded by

    Paul Kostukovsky
    This document is an application for a Single Pilot Exemption. It collects personal information about the applicant such as name, address, pilot certificates held. It documents the applicant's flight experience, including total flight hours and hours in various aircraft. It also records any flight training received and the results of an evaluation. Required supporting documents are listed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    AEROMANIA Single Pilot Exemption 11421 Application

    Applicant Information
    Name: Certificate Number Grade of Certificate Medical Medical Date

    Street Address Height - inches Weight - pounds Name of Medical Examiner

    City, State, ZIP Hair Color Eye Color Gender Nationality

    eMail Address Phone Company Name - Optional

    Form of ID ID Number Expiration Date

    Record of Pilot Time - Airplane Only


    Total 1000 Instrument 75 Night 50 PIC Turbine PIC ← 500 → Turbine SIC CE500 Single Pilot

    Applicant Certification
    I certify that: 1) all information I provided on this application is complete and true to the best of my knowledge, and 2) I have
    read and understand the Pilot's Bill of Rights and the Privacy Act Statement.

    Applicant's Signature Date Signed

    Record of Training
    Ground Instruction
    Date Completed Instructor Name & Signature Certificate # Expiration Date

    Flight Instruction
    Aircraft Type Registration Airport(s) Flight Time

    Date Completed Instructor Name & Signature Certificate # Expiration Date

    Additional Instruction Required


    Subject(s) Hours Required Corrective Action

    Date(s) Instructor Name Certificate # Expiration Date

    Record of Evaluation
    Aircraft Type Registration Airport Oral Time Flight Time

    Date Evaluator's Name & Signature DPE # Expiration Date

    Required Documents
    Copies of Pilot Certificate (front & back)
    Medical Certificate
    Passport

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