bcaa.bm
APPLICATION FOR AIR TRAFFIC CONTROLLER'S LICENCE OR RATING
I. APPLICATION INFORMATION LICENCE RATING
Aerodrome Control Rating Examiner Rating On-the-job Training Instructor Rating
A. Full Name (First, Middle, Last)
J. Address & Contact numbers:
K. Employer's name, address & contact numbers:
L. Do you hold a current Medical Certificate? YES NO
II. LICENCE OR RATING APPLIED FOR ON THE BASIS OF:
A. Successful completion of the required
ATC UTP examination
Successful completion of on-the-job training
YES
Successful completion of a competency check
YES
B. Training at BCAA
approved TO
1. Successful completion of
training and examinations
III. THE FOLLOWING DOCUMENTS MUST BE ENCLOSED WITH THIS APPLICATION:
1. Copy of the Local Knowledge Examination and the Operational Review Completed
2. Copy of the letter or certificate of completion from a BCAA approved Training Organisation (TO)
3. Medical Certificate of Validation Form (ATC 03) and associated documents (class II FAA Medical Certificate and for initial application
verification of certificate details from the State of issue)
4. ATC Certificate of Competence Letter
5. Validation: Air Traffic Control Examiner Rating Checklist Form (ATC 05) - (Examiner/OJTI only)
6. Two (2) passport size photographs
I certify that the above information is true and correct to the best of my knowledge and that I am fully conversant with the
requirements of the Air Navigation (Overseas Territories) Order, for the time being in force.
It is an offence to make, with the intent to deceive, any false representation for the purpose of procuring the grant, issue,
renewal, or variation of a licence. Any person so doing renders himself liable, on summary conviction, to a fine not exceeding
£1000 (or equivalent) or on conviction on indictment to a fine or imprisonment for term not exceeding two years or both.
Signature of Applicant _____________________
PEL/Form ATC 01 (2018/12 Rev 1)
