Section/division:
Telephone number:
Physical address:
Form Number:
Office of the Director of Civil Aviation
011-545-1000
011-545-1070
Fax Number:
Ikhaya Lokundiza, 16 Treur Close, Waterfall Park, Bekker Street, Midrand, Gauteng
CA183-109
Private Bag X73, Halfway House 1685
Website: www.caa.co.za
DETAILS OF BANK ACCOUNT FOR PAYMENT OF PRESCRIBED FEE
Branch: Brooklyn, Pretoria
Branch Code: 011245
Account Number: 013007971
COMPULSORY CLIENT PAYMENT CODE (to be completed on deposit slip)
Over the counter payments
EFT, Internet, Wire, Electronic payments
Postal address:
Bank: Standard Bank of SA Ltd
Service/transaction
Fees: See CAR Part
187.01.1
APPLICATION FOR EXEMPTION/SPECIAL APPROVAL/RECOGNITION OF
ALTERNATIVE MEANS OF COMPLIANCE
NOTES:
1. Applications for exemptions and recognition of alternative means of compliance are made in terms of regulations 11.04.1 to
11.04.6 and the fee prescribed in regulation 187.01.1 is applicable.
2. Applications for normal exemptions must be submitted to the Director 30 days before the required effective date of the
exemption. If a shorter period is required due to urgency, a detailed motivation to such effect must accompany the
application.
3. An application for special approval is made in terms of the specific regulatory provision which authorizes special approvals.
4. A separate form must submitted for each individual application.
5. Insert a tick () in the applicable box(es) .
Application for exemption
Application for special approval
Application for recognition of alternative means of compliance
Application for extension of exemption/special approval or alternative means of compliance
1.
PARTICULARS OF THE APPLICANT
Name of applicant
Trade name (if applicable)
Residential address
Postal address
Telephone number
Telephone number (Work)
Cellular phone
Fax number
E-mail address
Interest of applicant in the
application
CA 183-109
23 NOVEMBER 2016
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2.
DETAILS OF THE APPLICATION
CAR/CATS against which application is sought
Description of person to be covered by application,
e.g. cabin crew, AME etc.
Description of object to be covered by application,
e.g. aircraft
Effective date of relief sought
Note: this date must be after thirty days from the
date of this application. If the relief is sought on a
date sooner than 30 days, provide detailed
motivation as required below.
Proposed end date of relief
Motivation for the application:
(a)
(b)
(c)
(d)
The motivation to cover the following:
If the requirement had already been substantially complied with, state the extent to which it has been
complied with
If an acceptable level of safety is proposed to comply with the prescribed requirement, state the full
details of such level of safety
If it is considered that the prescribed requirement is inappropriate or events have occurred to make it
unnecessary to comply with, provide the details thereof
Detailed motivation and safety analysis of the relief sought
CA 183-109
23 NOVEMBER 2016
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In the case of an application for extension of relief previously granted
( provide additional reasons why the relief should be extended)
Motivation for relief to commencement of the relief sought
CA 183-109
23 NOVEMBER 2016
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SIGNATURE OF
APPLICANT
Capacity of signatory
CA 183-109
NAME IN BLOCK LETTERS
23 NOVEMBER 2016
DATE
Page 4 of 4