Form. No.

RPPL-F-106E
APPLICATION FOR THE INITIAL ISSUE OF A
AMDT No. 4.0 PART-FCL AIRLINE TRANSPORT
Page No. 1 of 5 PILOT LICENCE

Issue Date: 14/08/2020 (AEROPLANE)

NOTE: European Commission Regulation (EU) No. 1178/2011 as amended, requires that an individual has all of
their licences administered by the National Aviation Authority that holds their medical records (Part MED.A.030
and FCL.015).
If your medical records are not held by the IAA, your application will be rejected.

Please complete the form in BLOCK CAPITALS having read the GUIDANCE NOTES attached to this form.

1. PERSONAL DETAILS

Surname ......................................................................................... First Name(s) …...............................................................................

Title (Mr / Mrs/ Ms etc) .................................................................... Date of Birth (dd/mm/yyyy) .............................................................

Nationality ....................................................................................... Place of Birth (Town) …....................... (Country) ….......................

Permanent address ………........................................................................................................................................................................

......................................................................................................... Postcode .........................................................................................

Contact Tel. No. ............................................................................. Mobile Tel. No. ...............................................................................

E-mail address .........................................................................................................................................................................................

Address for correspondence (if different from above) ..............................................................................................................................

......................................................................................................... Postcode .........................................................................................

2. DETAILS OF FLIGHT CREW LICENCE(S) HELD

State of Issue Type of Licence Category of Licence Licence No. Expiry Date
(e.g. CPL, ATPL etc) (e.g. Aeroplane, Helicopter etc)

3. APPLICATION (tick as appropriate)

I am applying for the issue of a Part-FCL ATPL(A), on the basis of;

upgrade from a CPL(A)/IR __ upgrade from a MPL __

conversion of an ICAO ATPL(A) __

4. CLASS 1 MEDICAL CERTIFICATE

State of Issue Date of Expiry Date of AME Name, Limitations / IAA use only
Medical Class 1 Medical Centre & City Endorsements
Examination privileges
 Form. No. RPPL-F-106E
APPLICATION FOR THE INITIAL ISSUE OF A
AMDT No. 4.0 PART-FCL AIRLINE TRANSPORT
Page No. 2 of 5 PILOT LICENCE

Issue Date: 14/08/2020 (AEROPLANE)

5. FLIGHT EXPERIENCE

Please complete sections 1 to 7. (NOTE: Presented logbooks shall comply with the requirements of PLAM 024)

1. TOTAL FLIGHT TIME Part-FCL Hours IAA use only

minima (Hrs) completed
1. Total flight time as pilot of aeroplanes 15001

2. Flight time in multi-pilot operations on aeroplanes (State Type(s) below) 5002

(state type(s))
(Type(s)…….……………………………………………………………………….)

3. Please complete (a) or (b) or (c) as applicable

(a) Flight time as pilot-in-command (min. 70 hours) and as pilot-in-command
}2503 PIC _________
under supervision of aeroplanes PICUS _________
OR
(b) Flight time as pilot-in-command of aeroplanes 2503
OR
(c) Flight time as pilot-in-command under supervision of aeroplanes 5003

4. Cross-country flight time as pilot of aeroplanes 2004

5. Cross-country flight time as pilot-in-command or pilot-in-command under 1005

supervision of aeroplanes

6. Instrument time on aeroplanes 75

7. Night flight time as pilot-in-command or co-pilot of aeroplanes 1006

1 Other flight time will be credited as follows; Credit claimed IAA use only
(Hours)
- as pilot of helicopters (max. credit 750 hrs)
- as pilot in command of touring motor gliders or gliders (max. credit 30 hrs)
- as flight engineer (counted at ½ rate – max. credit 250 hrs)
- FNPT and Flight Simulator time (max. FNPT credit 25 hrs – max. combined credit 100 hrs) (FNPT) ________
(FS) ________
2
Other flight time will be credited as follows;
- multi-pilot operations on helicopters (max. credit 250 hrs) (State type(s) ……………………..)
- multi-pilot operations as flight engineer (counted at ½ rate - max. credit 250 hrs)

3 (a) flight time as PIC or PICUS of helicopters will be credited up to a max. credit of 125 hrs (PIC) ________
(of which a max. of 35 hours can be credited against the min. PIC requirement)
(PICUS) ________

(b) flight time as PIC of helicopters will be credited up to a max. credit of 125 hrs
(c) flight time as PICUS of helicopters will be credited up to a max. credit of 250 hrs

4 Cross-country
flight time as pilot of helicopters will be credited up to a max. credit of 100 hrs

5 Cross-country flight time as pilot-in-command or pilot-in-command under supervision of

helicopters will be credited up to a max. credit of 50 hrs
6 Night flight time as pilot-in-command or co-pilot of helicopters will be credited up to a max.
credit of 50 hrs
 Form. No. RPPL-F-106E
APPLICATION FOR THE INITIAL ISSUE OF A
AMDT No. 4.0 PART-FCL AIRLINE TRANSPORT
Page No. 3 of 5 PILOT LICENCE

Issue Date: 14/08/2020 (AEROPLANE)

6. ATPL(A) THEORETICAL KNOWLEDGE

EASA Member State under whose Type of exams passed Date of final ATPL(A) examination IAA use only
authority exams were passed (State ‘EASA’, or ‘National’) pass

7. ATPL(A) SKILL TEST

Date of ATPL(A) Aircraft type Aircraft registration / Name of Examiner Examiner Number IAA use only
skill test pass Simulator Code

8. ENGLISH LANGUAGE PROFICIENCY (ELP)

Date of ELP Assessment Level achieved Name of Examiner Examiner Number IAA use only

9. IAA SUMMARY PRIVACY NOTICE

How will we use your information?

The information you provide to us via this form will be used to enable us to carry out our regulatory duties including processing your
application for the issue of an Airline Transport Pilot Licence (ATPL), the administration and maintenance of subsequent licence and
for enforcement purposes. We will not disclose any of your information to any organisation without your explicit consent, except
where we are obliged to do so under relevant EU and Irish legislation, or to comply with law enforcement agencies.
Where can you find out more?
To find out more about how the IAA respects your privacy, please read our detailed privacy notice at https://www.iaa.ie/home/footer-
tools/privacy or contact our Data Protection Officer at [email protected], or write to Data Protection Officer, Irish Aviation
Authority, The Times Building, 11-12 D'Olier Street, Dublin 2, D02 T449.

10. APPLICANT’S DECLARATION

I hereby declare that:-
1) I do not hold a Part-FCL licence issued by another Member State;
2) I have not applied for a Part-FCL flight crew licence in another Member State;
3) I have never held a flight crew licence, issued another Member State, which was revoked or suspended.
4) My related aeromedical records are based in Ireland and all recent copies of medical reports have been submitted by my
AME.
5) I have read and understand the content of PLAM 024 and my submitted logbooks comply with same.
I further declare that the information given in this form is true and correct to the best of my knowledge and belief.

Applicant’s Signature .................................................................................................... Date ..............................................................

Note: It is an offence for a person to make, procure to be made, or assist in making any false representations for the purpose of
procuring for any reason the issue, validation, extension or re-issue of a licence or the issue, renewal or revalidation of a rating,
authorisation or certificate, whether for that person or any other person.
 Form. No. RPPL-F-106E
APPLICATION FOR THE INITIAL ISSUE OF A
AMDT No. 4.0 PART-FCL AIRLINE TRANSPORT
Page No. 4 of 5 PILOT LICENCE

Issue Date: 14/08/2020 (AEROPLANE)

GUIDANCE NOTES, PAYMENT FORM & SUBMISSION INSTRUCTIONS

Guidance Notes
In order for the IAA to process your application as quickly as possible, it is important that you complete the application form correctly.
Please complete the form in conjunction with the following guidance notes.

Section 1 – Personal Details

Please ensure that your First Name(s) are entered exactly as per the ‘evidence of identity’ document that you submit with your
application - see Submission instructions at the end of this form.

The permanent address will be entered on your Part-FCL ATPL(A), and will also be the address to which the licence will be sent. If
you want the licence sent to an alternative address, please enter the details under ‘correspondence address’.

Section 2 – Details of Flight Crew Licence(s) held

Please enter details of any current or expired/lapsed flight crew licence(s) (including foreign licences) held.

Section 3 - Application

Please indicate the basis on which your application for the initial issue of a Part-FCL ATPL(A) is being made.

Section 4 – Class 1 Medical Certificate

Please enter details of your valid EU Part-MED Class 1 medical certificate.

Note: European Commission Regulation (EU) No. 1178/2011 as amended, requires that an individual has all of their licences
administered by the National Aviation Authority that holds their medical records (Part MED.A.030 and FCL.015).If your medical
records are not held by the IAA, your application will be rejected

Section 5 – Flight Experience

Please enter details of your flight experience in sections 1 to 7 of the table.

Credit for flight time in an aircraft category other than aeroplanes can only be claimed if you hold a pilot licence, or equivalent
privileges, for the appropriate category of aircraft.

Section 6 –ATPL(A) Theoretical Knowledge

Please enter details of the ATPL(A) theoretical knowledge examinations passed.

Section 7 – ATPL(A) Skill Test

Please enter details of your ATPL(A) skill test pass.

Note: - an ATPL(A) skill test will only be accepted for licence issue if the examiner has reviewed the IAA’s National Procedures and
gave notification of test through the website.

Section 8 – English Language Proficiency

Please enter details of your most recent ELP assessment.

Section 10 – Applicant’s Declaration

This section must be completed by the applicant after reviewing all information entered on the application form. If you are unable to
agree with any of the statements in the declaration, please contact the Personnel Licensing Office for further advice before
submitting this application.
 Form. No. RPPL-F-106E
APPLICATION FOR THE INITIAL ISSUE OF A
AMDT No. 4.0 PART-FCL AIRLINE TRANSPORT
Page No. 5 of 5 PILOT LICENCE

Issue Date: 14/08/2020 (AEROPLANE)

SUBMISSION INSTRUCTIONS (see Guidance Notes)

Please note that failure to submit all required documentation

may result in the return of your application
Send your completed application form to:
Personnel Licensing Office, Irish Aviation Authority, The Times Building, 11-12 D’Olier Street, Dublin 2, Ireland.
Alternatively, you may deliver your application in person to the above address. Our counter service is available Monday – Friday
(excluding Bank holidays) between the hours of 10.00 -13.30 (local time). Please note that we do NOT offer a same-day service
for the initial issue of a Part-FCL ATPL(A). We aim to process applications within 15 working days. Also note that your
application may be delayed if the IAA has not received a copy of the skill test report form and required supporting documentation
from the Examiner.
Please enclose the following with your application:-
__ All original flying logbooks. If you have an electronic logbook, please print all pages and sign each page as a true record.
Note: in all cases, original signatures of the aircraft Commander are required if claiming PICUS time - electronic signatures are
not accepted
__ Copy of your valid Part-MED Class 1 medical certificate.
__ Copy of your Passport or National Identity card as evidence of identity.
__ Copy of your ATPL(A) examination results (if available).
__ Copy of the completed ATPL(A) skill test report form (RPPL.F.147).
__ Completed payment form (if paying by credit / debit card), or cheque / postal order.
__ Copy of ICAO ATPL(A) and validating medical certificate ( ICAO ATPL(A) conversions ONLY)
__ Completed English Language Proficiency Ground Examination form (RPPL-F-270) (ICAO ATPL(A) conversions ONLY)
__ Copy of flight crew licence(s) / qualification(s) and validating medical certificate(s) (if claiming credit in Section 5 for flight
experience in an aircraft category other than aeroplanes, or as Flight Engineer).
PAYMENT FORM
The current ATPL(A) issue fee can be found under ‘Fees for Flight Crew Licensing’ on the IAA website (www.iaa.ie). For existing
holders of an IAA-issued Part-FCL CPL(A)/IR, the issue fee includes the transfer of all valid ratings currently endorsed on the
licence - endorsement of additional rating(s) (e.g. additional Type rating(s) etc will incur an additional fee per rating.
Full details of fees charged and levied by the IAA are published in the Irish Aviation Authority (Fees) (No. 2) Order.
I am paying by:-
CREDIT / DEBIT CARD __ CHEQUE __ POSTAL ORDER __

- PLEASE DO NOT SEND CASH -

Please make cheques payable to ‘Irish Aviation Authority’.
Please note that we do not accept AMERICAN EXPRESS or DINERS CARD.
If paying by credit or debit card please complete the information required below (in block capitals). Note: All credit card details are
destroyed upon completion of the transaction.

Name of Card holder (as stated on the card) ____________________________________________________________________

Card Number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Valid from: __ __ / __ __ Expiry Date __ __ / __ __
Security Code (last 3 digits on signature strip on reverse of card) __ __ __