APPLICATION FOR INITIAL / AMENDMENT / RENEWAL OF PART-66 AIRCRAFT
MAINTENANCE LICENCE (AML)
EASA FORM 19
(Page 1)
APPLICANTS DETAILS :
Name :
Address :
Phone :
Email (optional) :
Nationality :
Fax (optional) :
Date and Place of Birth :
PART-66 AML DETAILS (if applicable) :
Licence No :
Date of Issue :
EMPLOYER’S DETAILS :
Name :
Address :
Maintenance Organisation Approval Reference :
Phone :
Fax :
APPLICATION FOR: (Tick the relevant box or boxes)
Initial AML
Rating
Turbine Aeroplane
Piston-engine Aeroplane
Turbine Helicopter
Piston-engine Helicopter
Avionics
Piston-engine non-pressurised
airplane of 2000 kg MTOM
and below
Large aircraft
Aircraft other than large
aircraft
Amendment of AML
A
Renewal of AML
B1
B2
B3
C
Aircraft type rating endorsement / sub-group rating endorsement / group rating endorsement (if applicable) :
(specify the type rating according to Appendix I of the AMC of Part-66,with the engine between brackets)
OR limitation removal (delete as appropriate)
I wish to apply for initial/amendment/renewal of Part-66 AML as indicated and confirm that the information contained in this form was
correct at the time of application.
I herewith confirm that :
1)
I am not holding any Part-66 AML issued in another Member State,
2)
I have not applied for any Part-66 AML in another Member State and,
3)
I never had a Part-66 AML issued in another Member State which was revoked or suspended in any other Member State.
I also understand that any incorrect information could disqualify me from holding a Part-66 AML.
Signed :
Date :
EASA FORM 19 – Issue 3.1
Name :
EASA FORM 19 – Issue 3.1
APPLICATION FOR INITIAL/AMENDMENT/RENEWAL OF PART-66 AIRCRAFT
MAINTENANCE LICENCE (AML)
EASA FORM 19
(Page 2)
SIGNATURE OF
CONFIRMATION :
MAINTENANCE EXPERIENCE ON AIRCRAFT :
I wish to claim the following credits (if applicable) :
Experience credit due Part-147 training
Examination credit due equivalent exam certificates
Please enclose all relevant certificates
Recommendation (if applicable): It is hereby certified that the applicant has met the relevant maintenance knowledge and experience
requirements of Part-66 and it is recommended that the competent authority grants or endorses the Part-66 AML.
Signed :
Name :
Position :
Date :
Information listed on the licences is contained in a data file. In accordance with the provisions of articles 34 to 38 of the modified law n° 78-17 of January
6th, 1978, license holders have the benefit to access and correct the personal information with regard to them.
This right can be exerted by mail with an attached copy of the applicant’s ID addressed to:
OSAC – Pôle Formation
Immeuble Zénéo - Bât. B
14 Boulevard des Frères Voisin
92137 Issy-les-Moulineaux CEDEX.
EASA FORM 19 – Issue 3.1