Guidance Material For Reduced Vertical Separation Minimum

APPENDIX 5: REDUCED VERTICAL SEPARATION MINIMUM & REQUIRED

NAVIGATIONAL PERFORMANCE APPLICATION FORM

Department of Civil Aviation Reduced Vertical Separation Minimum &

Ministry of Transport and Required Navigational Performance
Communications
Application Form

PART A – Details of Applicant

A1 Please indicate which applies to you:

Aircraft to be operated by an AOC holder
Aircraft to be operated privately (provide the name of the legal entity below)

A2 Are you an individual or group of individuals?

Yes No
Are you an incorporated company or association?
Yes No
Are you an incorporated of both individual(s) and incorporated company(s) or association(s)?
Yes No

A3 Details of the Operator

Name ------------------------------------ Company ----------------------------------------------

Date of Birth ------------------------------------

Have you attached proof of ID? Yes No

If the applicant is an individual, proof of applicant’s identity is a mandatory requirement.

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A4 Provide the following contact details.

Registered Business Address (which is shown in AOC)

-----------------------------------------------------------------------------------------------------------------

Business Location -------------------------------------------------------------------------------------

Phone ----------------------------------------
Mobile ----------------------------------------
Facsimile ----------------------------------------
Email --------------------------------------------------------------------------------------
Postal address --------------------------------------------------------------------------------------

A5 Aircraft Details

Aircraft Manufacturer ------------------------------

Serial Number ------------------------------
Registration ------------------------------
Aircraft Model ------------------------------
Proposed date for the commencement
of RVSM operations ------------------------------

This application is for multiple aircraft of the same type Appendix A has been completed

A6 Aircraft History

Has this aircraft previous under had RVSM approval Yes > Copy Attached No

Former registration under which approval was issued -----------------------------------------------

Previous Operator --------------------------------------------------
Previous approval issued by (Regulatory Body) ------------------------------------------------
Country of Issue --------------------------------------------------
Date of Issue, if known --------------------------------------------------

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Second Aircraft Details

Aircraft Manufacturer ---------------------- Serial Number ------------------------
Registration ------------
Aircraft Model -----------------------------------
Proposed date for the commencement of RVSM operations. -------------

Third Aircraft Details

Aircraft Manufacturer ---------------------- Serial Number ------------------------
Registration ------------
Aircraft Model ------------------------------------
Proposed date for the commencement of RVSM operations. -------------
Forth Aircraft Details
Aircraft Manufacturer ----------------------- Serial Number ------------------------
Registration -----------
Aircraft Model ----------------------------------
Proposed date for the commencement of RVSM operations. ------------

Fifth Aircraft Details

Aircraft Manufacturer ---------------------- Serial Number ------------------------
Registration ------------
Aircraft Model ---------------------------------
Proposed date for the commencement of RVSM operations. -------------

Sixth Aircraft Details

Aircraft Manufacturer ---------------------- Serial Number ------------------------
Registration ------------
Aircraft Model ------------------------------------
Proposed date for the commencement of RVSM operations. -------------

Seven Aircraft Details

Aircraft Manufacturer ---------------Serial Number ------------------------
Registration ------------
Aircraft Model -------------
Proposed date for the commencement of RVSM operations.-------------------

Eight Aircraft Details

Aircraft Manufacturer --------------Serial Number ------------------------
Registration --------------
Aircraft Model ---------------------------
Proposed date for the commencement of RVSM operations. -------------------

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 Guidance Material For Reduced Vertical Separation Minimum

Department of Civil Aviation Reduced Vertical Separation Minimum &

Ministry of Transport and Required Navigational Performance
Communications Application Form

PART B-Technical Information

B1 Provide the following maintenance details

Maintenance Organization ---------------------------------------------------------------------------

May DCA deal directly with the maintenance organization to gain access to the aircraft logbooks?
Yes > provide contact details No > provide details of an alternative contact

Contact Details
Phone --------------------- Mobile ------------------------- Facsimile ------------------------
Email ----------------------------------------------------------------------------------------------------

Are the maintenance personnel RVSM trained? Yes No

Do you intend to conduct in house maintenance? Yes No
Is the organization qualified to carry out the ongoing RVSM maintenance? Yes No
Dose the maintenance organization have RVSM type and general procedures? Yes No

B2 Provide copies of the relevant areas of your manuals to satisfy the requirements of this
application
regarding the continued airworthiness of the aircraft.
General RVSM maintenance procedures. Attached
Maintenance Programmes Attached
Approvals to conduct RVSM maintenance Attached
Supporting documentation & Maintenance Worksheets Attached

B3 Provide the following documentation to support your application

AFM Statement confirming the aircraft is RVSM and Supplemental Type Certificated
RNP Compliant
Attached OR Attached N/A (Factory approved
From new)
AFM Revision or Supplement MEL pages applicable
Attached Attached

RVSM Service Bulletin

Attached N/A (Factory approved from new)

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B4 What method will be used to conduct height monitoring?

---------------------------------------------------------------------------------------------------------------

B5 Is an RNP operational authorization required? Yes No

If yes, what type RNP 10 RNP 4

Documents required by are attached

Documents required by are attached

B6 Detail the method of RVSM training to be used for your flight crew.

a) External Training Provider Providers Name ----------------------------

OR
b) Internal Training & Checking for all Pilots within our approved organization for which the
amendment to include RVSM into our Training and Checking manual is attached.
OR
c) Internal Training & Checking for all Pilots within our approved organization for which the
RVSM training syllabus has previously been approved by DCA.

B 7 Supply the names and certificates of completion for crew who have completed
RVSM and RNP training.
If applicable
Name -------------------------------------------------------- RVSM Training Certificate Attached
RNP Certificate Attached

Name -------------------------------------------------------- RVSM Training Certificate Attached

RNP Certificate Attached

Name -------------------------------------------------------- RVSM Training Certificate Attached

RNP Certificate Attached

Name -------------------------------------------------------- RVSM Training Certificate Attached

RNP Certificate Attached

Name -------------------------------------------------------- RVSM Training Certificate Attached

RNP Certificate Attached

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