Fillable ACCORDING TO OTAR PART 119 APPLICATION FOR AN (Bermuda Civil Aviation Authority)

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ACCORDING TO OTAR PART 119 APPLICATION FOR AN (Bermuda Civil Aviation Authority)

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  • 74 check-boxes
  • 80 other fields

Country of origin: UK
File type: PDF

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bcaa.bm
1
Form
No.:
9001A
Last
Updated:
11 Feb 2019
APPLICATION FOR AN AIR OPERATOR CERTIFICATE
ACCORDING TO OTAR PART 119
Managemen
t Personnel/Organization (Part A)
Aircraft Fleet (Part B)
Special Authorities (Part B)
Maintenance System (Part C)
Applicant
AOC No. Oper
ator
Place Date
Signature o
f Accountable Manager
This form is used for initial issue, variation/amendment, and renewal of the AOC. For initial issue
and renewal, please complete the whole form. For variation, only complete the cover page and the
parts relevant to the variation. Incomplete forms will be returned and not processed.
The form includes:
Page 1: Cover Page
Page 2: Part A – Management Information
Page 3 + 4: Part B – Aircraft Type Information (complete separate Part B for each type)
Page 5: Part C – Maintenance System (complete separate Part C for each type)
This Form
9001 shall be submitted with all supporting appendices and documents to:
Bermuda Civil Aviation Authority,
Attn: Director of Operations, P.O. Box GE218,
St. George’s GE BX
Examples:
New Aircraft (Type) Form,9001: cover page and Part B/C, OM revision incl. Revision List, MEL,
OTAR 91,119 & 121 Compliance checklist (If applicable), Passenger Liability
Insurance, all appendices concerning Maintenances System, Lease
Agreement (if applicable), Airport utilization rights.
Deletion of Aircra
ft Form 9001: cover page and Part B, Passenger Liability Insurance, relevant
AOC extract
Appendices
BCAA Form
9001A for Accountable Manager/Postholder(s)/Deputy (obligatory for initial issue)
Applicatio
n for Authorization of Foreign Ownership of A/C
Lease Agre
ement (A/C Management Contract)
Operating Li
cence
Proof of Insuranc
e
OM Revisio
n (including OM compliance revision list)
MEL
Applicatio
n for Special Authorities/Approvals
OTAR 91,119 &
121 Compliance checklist
Maintenan
ce System Appendices (See Part C)
Initial Issue
Variation/Amendment
Renewal
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signature
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bcaa.bm
2
Form
No.:
9001A
Last
Updated:
11 Feb 2019
Part A – Management Information
Operator’s Name
Business Address
Phone Number
Fax Number
E-Mail
Management Personnel
Function
Phone No.
E-Mail
Accountable Manager
Accountable Manager (BDA)
Quality Manager
Safety Manager (SMS)
Postholder Flight Operations
Postholder Ground
Operations
Postholder Crew training
Postholder Maintenance
System
bcaa.bm
3
Form
No.:
9001A
Last
Updated:
11 Feb 2019
Part B – Aircraft Type Information
Operator’s Name: ________________
Aircraft Type
Make-Model-Series
Serial Number
A/C Registration Marks
Pax Seats
MTOM
Main Base
Dry Lease- In (if applicable)
Lease From/To
Delivery Date
Commercial Operation Date
Deletion Date
Aircraft Owner’s name:
Address and Nationality:
Operational Lease (Please submit copy of leasing contract)
Financial Lease
Types of Operation
Passengers Only Passengers and Cargo Cargo Only
Scheduled
Non-Schedul
ed
Area(s) of Operation
Define by Lat/Long:
Special Limitations
VFR Day Only
VFR Day/Night Only
Other:
bcaa.bm
4
Form
No.:
9001A
Last
Updated:
11 Feb 2019
Requested Special Authorizations/Approvals
CAT II
RVR (m)
DH (ft)
CAT IIIA
RVR (m)
DH (ft)
CAT IIIB
RVR (m)
DH (ft)
CAT IIIC
RVR (m)
DH (ft)
LOWER THAN STANDARD CAT I
RVR (m)
DH (ft)
EVS
LVTO
RVR (m)
RVR (m)
DH (ft)
MNPS
ADS-C/CPDLC
ADS-B
RVSM
RNP 10 (RNAV 10)
BRNAV (RNP5)
RNP4
P-RNAV (RNP1)
RNP APCH
RNP AR APCH
ETOPS Min NM
EDTO Min
DG
USE OF EFB
bcaa.bm
5
Form
No.:
9001A
Last
Updated:
11 Feb 2019
Part C – Maintenance System
Operator’s Name: ________________
Maintenance Arrangements
Contracted Maintenance (*)
Name of Contracted EASA-145 organization:
CAMO
Name of Contracted OTAR 39 organization:
Contracte
d Maintenance Support Services
Name of Contracted Maintenance Support Organization
•
MME or MOE
/MME
•
Maintenan
ce Contract (*)
•
Maintenanc
e Support (*)
•
CAMO
•
Aircraft
Maintenance Programme (*)
•
Reliabil
ity programme (*) (if applicable)
•
Aircraft
tech Log System
(*) for each aircraft type
bcaa.bm
6
Form
No.:
9001A
Last
Updated:
11 Feb 2019
FOR BCAA INTERNAL USE ONLY
CAT II RVR (m) DH (ft)
CAT IIIA RVR (m) DH (ft)
CAT IIIB RVR (m) DH (ft)
CAT IIIC RVR (m) DH (ft)
LOWER THAN CAT I RVR (m) DH (ft)
EVS RVR (m) DH (ft)
LVTO RVR (m)
AW OPS/S
PEC
MNPS
ADS-C/CPDLC
ADS-B
RVSM
RNP 10 (RNAV 10)
BRNAV (RNP5)
RNP4
P-RNAV (RNP1)
RNP APCH
RNP AR APCH
ETOPS Min NM
EDTO Min
DG
USE OF EFB
Date of Issue
Name & Signature
Maintenance System Approval
Statement
AOC
Operating License
Invoice Number
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signature
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ACCORDING TO OTAR PART 119 APPLICATION FOR AN (Bermuda Civil Aviation Authority)

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Completed 22 July 2021

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