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DPE/INSTRUCTOR Booking Form
Personal Information
First Name and ALL middle names as indicated on your identification certificate*

All names listed in passport
Last Name:*

E-Mail:*

Address Line 1:*

Address Line 2:

City:*

Post Code:*

Country*

Nationality*

Gender:

Date of Birth:*

Phone:*

Height (Inches Only):*

Weight (Pounds Only):*

Service Required*

Federal Tracking Number (FTN)*

1st TEST Required (if applicable)

2nd TEST Required (if applicable)

3rd TEST Required (if applicable)

Requested date of Service

US A/C Reg, Make & Model (If Required)

Name of Test A/C Maintenance Facility and Name of IA responsible for the Annual Inspection*

Do you hold an FAA Pilot Certificate? If so, please indicate certificate number and grade.*

Do you hold an FAA Medical Certificate?*

If so, what Class?
Have you ever had an FAA Certificate Revoked?*

Non-FAA ICAO Licenses & Ratings held*

Country of Issue
FAA Endorsing Instructor`s FULL Name and Certificate Number - MANDATORY FOR FLIGHT TESTS*

If applicable
WARNING!
IF THE AIRMAN CERTIFICATE AND/OR RATING APPLICATION (8710-1) IS NOT COMPLETED AND SUBMITTED TO THE EXAMINER AT LEAST 24 HOURS PRIOR TO THE EXAMINER’S ARRIVAL, THE TEST OR SERVICE WILL NOT BEGIN AS SCHEDULED AND THE EXAMINER WILL LEAVE IMMEDIATELY.
By checking the box below, you are confirming that you (and your FAA CFI if flight test) have read, understand & agree with
SCH AIRCRAFT CONSULTANCY LTD`s Terms & Conditions of Service
and that Bookings cannot be confirmed until full payment of fees has been received.
I Agree*

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