CAA International

Overseas Venue - Part-66 Aircraft Maintenance Licence Application for Written Examination
Please complete the form in BLOCK CAPITALS using type, black or dark blue ink
1. Personal Details CAA Personal Reference number (if known) Part 66 Licence No (if held) Surname Title Forename Date of birth Town of birth Country of birth BCAR Licence No

Nationality Permanent Address City Telephone no. Email address Postcode / zip code

Country Alternative tel no. Fax no.

Address City 2. Venue

Exam Centre

Postcode / zip code CAA International Exam Centre

Country

AM Exam date 1st choice

PM 2nd choice

Please see our website www.caainternational.com for exam dates and venues 3. Category / Sub Category Of Examination (tick as appropriate) Category Aeroplane Turbine Aeroplane Piston Helicopter Turbine Helicopter Piston Avionic 4. For CI Use Only Date Enclosures INT Version
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A A1 A2 A3 A4 N/A

B B1-1 B1-2 B1-3 B1-4 B2

Cheque / PO/Cash/Mastercard/Visa Receipt No

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5. Additional Information I am applying to take examinations to convert from a BCAR Section L AMEL I am applying to take examinations to remove limitations from my Part-66 Licence I hold a Part-66 licence in a di erent category to the examinations for which I am applying 6. EXAMINATION PAPERS (Please put check box(es) against the modules(s) you wish to take at this examination) Module CI Use only Paper No % 1. Mathematics 2. Physics 3. Electrical Fundamentals 4. Electronic Fundamentals 5. Digital Techniques / Electronic Instrument Systems 6. Materials & Hardware 7. Maintenance Practices 8. Basic Aerodynamics 9. Human Factors Essay Module 7 Module 9 10. Aviation Legislation 11. Aeroplanes Aerodynamics, Structures and Systems 12. Helicopter Aerodynamics, Structures and Systems 13. Aircraft Aerodynamics Structures and Systems 14. Propulsion 15. Gas Turbine Engine 16. Piston Engine 17. Propellor Module 10 All Module CI Use only Paper No %

7. Payment Methods (see guidance notes) Please complete form CI/1187. Please refer to website for for current fees. 8. Declaration (*delete as appropriate) I declare that the information provided in this form is correct. I declare that I have not taken the above module exams within the last 90 days I have undertaken a course of retraining and have enclosed the course completion certicate to allow me to re-take the relevant modules in accordance with Part-66, Appendix II, 1.11 I agree to receive Engineering Safety material from the CAA only I do not wish to receive this safety material Signed By 9. Submission Instructions (see guidance notes) Send your completed application form to: CAA International Ltd, 3W Aviation House, Gatwick Airport South, West Sussex RH6 0YR or by fax: +44 (0) 1293 573992 Together with: *a certied copy of your passport where needed Click here to print INT Version
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Safety material from authorised sources

Date

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