bcaa.bm
IV. THE FOLLOWING DOCUMENTS MUST BE ENCLOSED WITH THIS APPLICATON:
V. CERTIFICATION:
APPLICATION FOR STUDENT AIR TRAFFIC CONTROLLER'S LICENCE
I. APPLICATION INFORMATION
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. STUDENT LICENCE APPLIED FOR ON THE BASIS OF TRAINING AT A BCAA APPROVED TRAINING ORGANISATION
a. Name of the BCAA approved Training Organisation (TO):
b. Successful completion of training and examinations:
c. Date of letter or certificate of completion from BCAA approved TO:
a. Application for Medical Certificate of Validation (ATC Form 03) and associated documents (class II FAA Medical Certificate
and for an initial application, verification of medical certificate details from the State of issue);
b. Copy of the letter or certificate of completion from a BCAA approved Training Organisation;
c. Copy of the English Proficiency Language assessment report;
d. Copy of the foreign Air Traffic Controller's Licence and verification confirming the particulars of the licence from the
State of issue; and
e. Two (2) passport size photographs.
I certify that the above information is true and correct to the best of my knowledge.
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 _____________________
Date: _______________________
PEL/Form ATC 02 (2018/12 Rev 1)
III. STUDENT LICENCE APPLIED FOR ON THE BASIS OF CURRENT FOREIGN AIR TRAFFIC CONTROLLER LICENCE
Holder of Foreign
Licence issued by:
