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Pre-training Survey Form

Pre-training Survey Form 2

Online Registration

Trainee Information

Family name*

First name*

Date of birth*

Place of birth*

Sex*

Male

Female

Nationality*

Passeport NB*

Place of issue*

Validity*

English level*

Trainee licence information

Type of licence*

ATP

CPL

Other*

Licence based in*

JAA

FAA

National Regulations

Licence number*

State of issue*

Valid until*

Multi Engine instrument rating*

Includedinlicence or

Valid until

Valid until*

Ratings on licence

Air craft type*

Valid until*

Hrs flows on type*

Date last flight*

Instructor rating*

NO

YES

Valid until (if YES)

On*

A / C Type*

Total time as pilot*

Including hours as Pic*

ANDF / O*

Hours flown on jet aircraft*

In case of first issue of a multi pilot type rating

MMC (multi crew certificate)*

Date of delivery*

By*

Hours as pilot flying on multi engine aircraft*

Date last flight*

Multi engine instrument rating

Valid until*

Or expired since*

Certify*

I undersigned certify that all the above statements are true and will comply with the general policy stated on this document

DECLARATION BY TRAINNE

Name*

Date*

Math Question

Don't fill this field!

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