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DGCA Foreign CPL Licence Convertion Sample Documents

STRICTLY SAMPLE COPIES*


Only for Reference

*Disclaimer: These forms should be taken as reference/ sample/ suggestion; just to get an idea about
how to prepare documents for DGCA license conversion. We or the site nor the person who has
typed this does not take any responsibilities in case of any complaints, lost, rejection or any other
problems due to these forms. Prepare these documents on school letter head.

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To Whomsoever It May Concern:

5 hrs PIC NIGHT

This is to certify that (Full Name) has over 5 hrs of night flight time as PIC including 10 take offs
and landings each between 15th June 2008 to 20th June 2008 meeting the requirements of DGCA for
conversion of FAA CPL to Indian CPL

True Extract from Log Book

DATE AIRCRAFT FROM TO DURATION TAKEOFF/


IDENTIFICATION LANDINGS

17th JUN CE-152 : N53396 KABC KABC 01:12 3

20th JUN CE-152 : KABC KABC 03:12 12


NN87262

21st JUN CE-172 : KABC KABC 00:54 2


N456AB

(Seal And Sign)


Chief Flight Instructor

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To Whomsoever It May Concern:

15 hrs PIC

This is to certify that (Full Name) has over 15 hrs of flight time as PIC between 15th June 2008 to
20th June 2008 meeting the requirements of DGCA for conversion of FAA CPL to Indian CPL

(Seal And Sign)


Chief Flight Instructor

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To Whomsoever It May Concern:

50 HRS CROSS COUNTRY

This is to certify that (Full Name) has completed the minimum requirement of 50 hrs of cross
country flight time as PIC as per the DGCA.

The details of flight are attached

(Seal And Sign)


Chief Flight Instructor

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To Whomsoever It May Concern:

100 hrs PIC

This is to certify that (Full Name) has logged over 100 hrs of flight time as PIC during his 10
months of training at (School Name)

(Seal And Sign)


Chief Flight Instructor

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To Whomsoever It May Concern:

This is to certify that (Full Name) has completed a 120 NM cross country flight test by night
carried out by (Instructor Name) (CFI, CFII, MEI) consisting of a flight not less than 120 NM and
returning to the place of departure without landing elsewhere as per the DGCA requirements.

True Extract from Log Book

DATE AIRCRAFT FROM TO DURATION DISTANCE DAY/


IDENTIFICATION NIGHT

16th JUN CE-172 : N145ES KABC KABC 03:18 243.4 NM NIGHT


2008 (O/F KGGG)

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

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PERFORMA FOR THE 120 NM CROSS COUNTRY FLIGHT TEST BY NIGHT FOR THE ISSUE
OF COMMERCIAL PILOT LICENSE

NAME: (Full Name)


LICENSE NUMBER: ______________ ROUTE: KABC-(O/F KGGG)-KABC
DATE: 16th June 2008 FLIGHT TIME: 03:18
TYPE OF A/C: CE-172 IDENTIFICATION: N145ES
DISTANCE: 243.4 NM (121.7 NM Straight Line) EXAMINER:

Sr. No OPERATIONS BY NIGHT ASSESSMENT

1 (a) Preparation- ATC Clearance, MET Briefing S


(b) Navigational Log
(c) Flight Computer, Allied Equipment, Maps etc
2 Map Reading S
3 Calculation of Ground Speed and ETA reporting point/Destination S
4 Drift Calculation S
5 Selection of Fuel Tanks/Transfer from Auxiliary to Main S
6 General Flying En Route (Steering Course/Maintaining Altitude and S
Speed)
7 Approach to Destination for Landing S
8 Landing S
9 Precautions during Refueling En Route S

ASSESSMENT- AS: Above Standard S: Standard BS: Below Standard

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

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To Whomsoever It May Concern:

200 hrs Flight Time

This is to certify that (Full Name) has logged over 250 hrs of flight time during his 10 months of
training at (School Name)

Seal and Sign


Chief Flight Instructor

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To Whomsoever It May Concern:

This is to certify that (Full Name) has completed a 250 NM cross country flight test by day carried
out by (Instructor Name) (CFI, CFII, MEI) consisting of a flight not less than 250 NM in the course
and at least one full stop landing at an aerodrome other than the aerodrome of departure as per the
DGCA requirements.

True Extract from Log Book

DATE AIRCRAFT FROM TO DURATION DISTANCE DAY/


IDENTIFICATION NIGHT

15th JUN CE-172 : N145ES KABC KAMA 03:00 276 NM DAY


2008
15th JUN CE-172 : N145ES KAMA KABC 02:54 276 NM DAY
2008

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

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PERFORMA FOR THE 250 NM CROSS COUNTRY FLIGHT TEST BY DAY FOR THE ISSUE OF
COMMERCIAL PILOT LICENSE

NAME: (Full Name)


LICENSE NUMBER: _______________ ROUTE: KABC-KAMA-KABC
DATE: 15th June 2008 FLIGHT TIME: 05:54
TYPE OF A/C: CE-172 IDENTIFICATION: N145ES
DISTANCE: 552NM (276NM Straight Line) EXAMINER:_______________

Sr. No OPERATIONS BY DAY ASSESSMENT

1 (a) Preparation- ATC Clearance, MET Briefing S


(b) Navigational Log
(c) Flight Computer, Allied Equipment, Maps etc
2 Map Reading S
3 Calculation of Ground Speed and ETA reporting point/Destination S
4 Drift Calculation S
5 Selection of Fuel Tanks/Transfer from Auxiliary to Main S
6 General Flying En Route (Steering Course/Maintaining Altitude and S
Speed)
7 Approach to Destination for Landing S
8 Landing S
9 Precautions during Refueling En Route S

ASSESSMENT- AS: Above Standard S: Standard BS: Below Standard

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

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To Whomsoever It May Concern:

This is to certify that (Full Name) has completed a cross country flight of not less than 300 Nm in
the course of which full stop landings at two different aerodromes were made.

True Extract from Log Book

DATE AIRCRAFT FROM TO DURATION DISTANCE DAY/


IDENTIFICATION NIGHT

17th CE-172 : N145ES KABC KMN 03:36 310.6 Nm DAY


DEC O
2007
17th CE-172 : N145ES KMN KUSA 02:00 159.7 Nm DAY
DEC O
2007
17th CE-172 : N145ES KUSA KABC 01:54 151.1 Nm DAY
DEC
2007

(Seal And Sign)


Chief Flight Instructor

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To Whomsoever It May Concern:

ACCIDENT/INCIDENT FREE CERTIFICATE

This is to certify that (Full Name) , born on__________ has not been involved in any kind of
aircraft accident/incident related to Human/Pilot error during his 10 months of training at (School
Name)

Seal and Sign


Chief Flight Instructor

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To Whomsoever It May Concern:

CERTIFICATE OF AIRWORTHINESS OF AIRCRAFT

This is to certify that (Full Name) has gained flight experience at (School Name) on aircraft having
valid certificates of airworthiness.

Seal and Sign


Chief Flight Instructor

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SOLO CROSS COUNTRY STATEMENT

True Extract from Log Book


DATE AIRCRAFT FROM TO DISTANCE DURATION

29-10-2007 N734LY KABC KDWH 175 02:00


29-10-2007 N734LY KDWH KABC 175 02:24
04-11-2007 N145ES KABC KABI 131.8 02:12
04-11-2007 N145ES KABI KABC 131.8 01:48
07-11-2007 NN87262 KABC KXPR 101.1 01:36
07-11-2007 NN87262 KXPR KABC 101.1 01:24
09-11-2007 N734LY KABC KVSH 165.8 02:24
09-11-2007 N734LY KVSH KABC 165.8 02:36
23-11-2007 N24768 KABC KOSA 110.5 01:42
23-11-2007 N24768 KOSA KABC 110.5 02:30
26-11-2007 NN5061Q KABC KABI 131.8 02:12
26-11-2007 NN5061Q KABI KABC 131.8 02:36
27-11-2007 N53396 KABC KVSH 165.8 02:24
27-11-2007 N53396 KVSH KABC 165.8 02:48
07-12-2007 N456AB KABC KABI 131.8 02:48
07-12-2007 N456AB KABI KABC 131.8 02:18
17-12-2007 N145ES KABC KMNO 310.6 03:36
17-12-2007 N145ES KMNO KUSA 159.7 02:00
17-12-2007 N145ES KUSA KABC 151.1 01:54
19-12-2007 N145ES KABC KCWC 100.3 01:36
19-12-2007 N145ES KCWC KABC 100.3 01:12
19-12-2007 N12345 KABC KABI 131.8 01:54
19-12-2007 N12345 KABI KABC 131.8 01:36
21-12-2007 N53396 KABC KGGG 121.7 01:54
21-12-2007 N53396 KGGG KABC 121.7 02:30
09-01-2008 N734LY KABC KABI 131.8 02:00
09-01-2008 N734LY KABI KABC 131.8 01:48

Total Cross Country Flight Time : 69:12mins

Your Name Seal and Sign


Pilot under check Chief Flight Instructor

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To Whomsoever It May Concern:

This is to certify that (Full Name) has completed the FAA Commercial Pilot Airplane Single
Engine Land and Multiengine Land Checkride on 28th May 2008.

True Extract from Log Book

DATE AIRCRAFT FROM TO DURATION TAKEOFF/


IDENTIFICATION LANDINGS

28th MAY CE-152 : N300FD KDES KDES 01:12 3


2008

28th MAY BE-76 : N54321 KDES KDES 00:12 1


2008 (Complex Aircraft)

28th MAY BE-76 : N54321 KDES KDES 00:54 3


2008

Examiner sign
Approved Examiner/Instructor

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To Whomsoever It May Concern:

This is to certify that (Full Name) has completed the FAA Instrument Rating Airplane Checkride
on 26th Feb 2008.

True Extract from Log Book

DATE AIRCRAFT FROM TO DURATION APPROACHES


IDENTIFICATION

26th FEB CE-172 : N12345 KABC KABC 01:24 3


2008 (01:18 ILS GPS
Simulated) VOR

Examiner sign
Approved Examiner/Instructor

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To Whomsoever It May Concern:

This is to certify that (Full Name) has completed the FAA Private Pilot Airplane Single Engine
Land Checkride on 26th October 2007.

True Extract from Log Book

DATE AIRCRAFT FROM TO DURATION TAKEOFF/


IDENTIFICATION LANDINGS

26th OCT CE-152 : KABC KABC 01:24 3


2007 NN87262

Examiner sign
Approved Examiner/Instructor

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To Whomsoever It May Concern:

This is to certify that (Full Name) has completed the Airplane Single Engine Land General
Flying Test by Day with 3 Solo take off and landings carried out by (Instructor Name) (CFI, CFII,
MEI) in Cessna 152 : NN87262 as per the DGCA requirements.

True Extract from Log Book

DATE AIRCRAFT FROM TO DURATION TAKEOFF/


IDENTIFICATION LANDINGS

17th JUN CE-152 : KABC KABC 01:24 4


2008 NN87262

17th JUN CE-152 : KABC KABC 00:30 3


2008 NN87262

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

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CA40
GENERAL FLYING TEST BY DAY FOR ISSUE OF COMMERCIAL LICENCE
NAME: (Full Name) LIC No: ________ Valid Till: N/A
TYPES OF A/C FLOWN: CE-152 TOTAL HRS FLOWN: 119:36
TEST ON A/C TYPE: CE-152 REGN NO: NN87262
th
DATE 17 June 2008 TIME DAY: 01:24 (excluding 00:30 solo Landings)
Certified that the above information has been verified from the relevant documents.

Signature of Instructor/ Examiner


SR. NO MANEUVERS REMARKS

1 Cockpit Checks S
2 Starting Procedure S
3 Precaution before Taxing Out S
4 Taxing Procedure S
5 Engine Check S
6 Preflight Check S
7 Precaution before entering Runway/Line Up S
8 Takeoff S
9 Climbing Speed and Use of Power S
10 Procedure for Leveling out S
11 Level Flight
(a) Use of Correct Power S
(b) Use of Fore and Aft Trim S
(c) Keeping Lateral Level/Direction/Speed S

12 Level Turns
(a) Precaution before Turns S
(b) Rate Turns S
13 Climbing and Gliding Turns
(a) Use of Bank in Rate 1 Climbing Turn S
(b) Medium Gliding Turn with Flaps Up and Down (15 S
& 30 bank)
14 Asymmetric Handling
(a) In Climb NA
(b) In Flight NA
(c) Circuit and Approach NA

15 Descent and Ascent at given Rate/Speed S

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16 Correct Procedure for Joining Circuit/Circuit Pattern S
(90 Turns)
17 Stalling S
18 Spinning S
19 Landing
(a) With Full Flaps S
(b) With No Flaps S
(c) With Partial Flaps S
(d) With Simulated Asymmetric Engines NA

20 Precautionary Landing S
21 Forced Landing S
22 Steep Turn S
23 Action in Event of Simulated
(a) Engine Failure after Takeoff S
(b) Engine Fire after Takeoff S

24 Night Flying
(a) Correct Use of Cockpit Light NA
(b) Correct Procedure for Touchdown NA
(c) Landing with and without Landing Lights NA

FINAL ASSESSMENT: Satisfactory


ASSESSMENT- AS: Above Standard S: Standard BS: Below Standard

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

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To Whomsoever It May Concern:

This is to certify that (Full Name) has completed the Airplane Multi Engine Land General Flying
Test by Day with 3 take off and landings as sole manipulator of controls carried out by (Instructor
Name) (CFI, CFII, MEI) in Beechcraft Duchess : N54321 as per the DGCA requirements.

True Extract from Log Book

DATE AIRCRAFT FROM TO DURATION TAKEOFF/


IDENTIFICATION LANDINGS

18th JUN BE-76 : N54321 KDES KDES 01:24 4


2008

18th JUN BE-76 : N54321 KDES KDES 00:36 3


2008

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

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CA40
GENERAL FLYING TEST BY DAY FOR ISSUE OF COMMERCIAL LICENCE
NAME: (Full Name) LIC No: ________ Valid Till: N/A
TYPES OF A/C FLOWN: BE-76 TOTAL HRS FLOWN: 10:36
TEST ON A/C TYPE: BE-76 REGN NO: N54321
th
DATE 18 June 2008 TIME DAY: 01:24 (excluding 00:36 sole manipulator landings)
Certified that the above information has been verified from the relevant documents.

Signature of Instructor/ Examiner


SR. NO MANEUVERS REMARKS

1 Cockpit Checks S
2 Starting Procedure S
3 Precaution before Taxing Out S
4 Taxing Procedure S
5 Engine Check S
6 Preflight Check S
7 Precaution before entering Runway/Line Up S
8 Takeoff S
9 Climbing Speed and Use of Power S
10 Procedure for Leveling out S
11 Level Flight
(a) Use of Correct Power S
(b) Use of Fore and Aft Trim S
(c) Keeping Lateral Level/Direction/Speed S

12 Level Turns
(a) Precaution before Turns S
(b) Rate Turns S
13 Climbing and Gliding Turns
(a) Use of Bank in Rate 1 Climbing Turn S
(b) Medium Gliding Turn with Flaps Up and Down (15 S
& 30 bank)
14 Asymmetric Handling
(a) In Climb S
(b) In Flight S
(c) Circuit and Approach S

15 Descent and Ascent at given Rate/Speed S

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16 Correct Procedure for Joining Circuit/Circuit Pattern S
(90 Turns)
17 Stalling S
18 Spinning S
19 Landing
(a) With Full Flaps S
(b) With No Flaps S
(c) With Partial Flaps S
(d) With Simulated Asymmetric Engines S

20 Precautionary Landing S
21 Forced Landing S
22 Steep Turn S
23 Action in Event of Simulated
(a) Engine Failure after Takeoff S
(b) Engine Fire after Takeoff S

24 Night Flying
(a) Correct Use of Cockpit Light NA
(b) Correct Procedure for Touchdown NA
(c) Landing with and without Landing Lights NA

FINAL ASSESSMENT: Satisfactory


ASSESSMENT- AS: Above Standard S: Standard BS: Below Standard

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

Ad: Save Time and Money on your CPL course, Type rating (B737NG, A320 and ATR).
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To Whomsoever It May Concern:

This is to certify that (Full Name) has completed the Airplane Multi Engine Land General Flying
Test by Night with 3 take off and landings as sole manipulator of controls carried out by
(Instructor Name) (CFI, CFII, MEI) in Beechcraft Duchess : N54321 as per the DGCA
requirements.

True Extract from Log Book

DATE AIRCRAFT FROM TO DURATION TAKEOFF/


IDENTIFICATION LANDINGS

18th JUN BE-76 : N54321 KDES KDES 01:18 4


2008

18th JUN BE-76 : N54321 KDES KDES 00:30 3


2008

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

Ad: Save Time and Money on your CPL course, Type rating (B737NG, A320 and ATR).
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CA40
GENERAL FLYING TEST BY NIGHT FOR ISSUE OF COMMERCIAL LICENCE
NAME: (Full Name) LIC No: ________ Valid Till: N/A
TYPES OF A/C FLOWN: BE-76 TOTAL HRS FLOWN: 12:36
TEST ON A/C TYPE: BE-76 REGN NO: N54321
th
DATE 18 June 2008 TIME NIGHT: 01:18 (excluding 00:30 sole manipulator landings)
Certified that the above information has been verified from the relevant documents.

Signature of Instructor/ Examiner


SR. NO MANEUVERS REMARKS

1 Cockpit Checks S
2 Starting Procedure S
3 Precaution before Taxing Out S
4 Taxing Procedure S
5 Engine Check S
6 Preflight Check S
7 Precaution before entering Runway/Line Up S
8 Takeoff S
9 Climbing Speed and Use of Power S
10 Procedure for Leveling out S
11 Level Flight
(a) Use of Correct Power S
(b) Use of Fore and Aft Trim S
(c) Keeping Lateral Level/Direction/Speed S

12 Level Turns
(a) Precaution before Turns S
(b) Rate Turns S
13 Climbing and Gliding Turns
(a) Use of Bank in Rate 1 Climbing Turn S
(b) Medium Gliding Turn with Flaps Up and Down (15 S
& 30 bank)
14 Asymmetric Handling
(a) In Climb S
(b) In Flight S
(c) Circuit and Approach S

15 Descent and Ascent at given Rate/Speed S

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16 Correct Procedure for Joining Circuit/Circuit Pattern S
(90 Turns)
17 Stalling S
18 Spinning S
19 Landing
(a) With Full Flaps S
(b) With No Flaps S
(c) With Partial Flaps S
(d) With Simulated Asymmetric Engines S

20 Precautionary Landing S
21 Forced Landing S
22 Steep Turn S
23 Action in Event of Simulated
(a) Engine Failure after Takeoff S
(b) Engine Fire after Takeoff S

24 Night Flying
(a) Correct Use of Cockpit Light S
(b) Correct Procedure for Touchdown S
(c) Landing with and without Landing Lights S

FINAL ASSESSMENT: Satisfactory


ASSESSMENT- AS: Above Standard S: Standard BS: Below Standard

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

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To Whomsoever It May Concern:

This is to certify that (Full Name) has completed the Airplane Single Engine Land General
Flying Test by Night with 3 Solo take off and landings carried out by (Instructor Name) (CFI,
CFII, MEI) in Cessna 152 : N87262 as per the DGCA requirements.

True Extract from Log Book

DATE AIRCRAFT FROM TO DURATION TAKEOFF/


IDENTIFICATION LANDINGS

17th JUN CE-152 : KABC KABC 01:18 4


2008 NN87262

17th JUN CE-152 : KABC KABC 00:36 3


2008 NN87262

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

Ad: Save Time and Money on your CPL course, Type rating (B737NG, A320 and ATR).
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CA40
GENERAL FLYING TEST BY DAY FOR ISSUE OF COMMERCIAL LICENCE
NAME: (Full Name) LIC No: ________ Valid Till: N/A
TYPES OF A/C FLOWN: CE-152 TOTAL HRS FLOWN: 119:36
TEST ON A/C TYPE: CE-152 REGN NO: NN87262
th
DATE 17 June 2008 TIME DAY: 01:18 (excluding 00:36 solo Landings)
Certified that the above information has been verified from the relevant documents.

Signature of Instructor/ Examiner


SR. NO MANEUVERS REMARKS

1 Cockpit Checks S
2 Starting Procedure S
3 Precaution before Taxing Out S
4 Taxing Procedure S
5 Engine Check S
6 Preflight Check S
7 Precaution before entering Runway/Line Up S
8 Takeoff S
9 Climbing Speed and Use of Power S
10 Procedure for Leveling out S
11 Level Flight
(a) Use of Correct Power S
(b) Use of Fore and Aft Trim S
(c) Keeping Lateral Level/Direction/Speed S

12 Level Turns
(a) Precaution before Turns S
(b) Rate Turns S
13 Climbing and Gliding Turns
(a) Use of Bank in Rate 1 Climbing Turn S
(b) Medium Gliding Turn with Flaps Up and Down (15 S
& 30 bank)
14 Asymmetric Handling
(a) In Climb NA
(b) In Flight NA
(c) Circuit and Approach NA

15 Descent and Ascent at given Rate/Speed S

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16 Correct Procedure for Joining Circuit/Circuit Pattern S
(90 Turns)
17 Stalling S
18 Spinning S
19 Landing
(a) With Full Flaps S
(b) With No Flaps S
(c) With Partial Flaps S
(d) With Simulated Asymmetric Engines NA

20 Precautionary Landing S
21 Forced Landing S
22 Steep Turn S
23 Action in Event of Simulated
(a) Engine Failure after Takeoff S
(b) Engine Fire after Takeoff S

24 Night Flying
(a) Correct Use of Cockpit Light S
(b) Correct Procedure for Touchdown S
(c) Landing with and without Landing Lights S

FINAL ASSESSMENT: Satisfactory


ASSESSMENT- AS: Above Standard S: Standard BS: Below Standard

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Pilot under check Approved Examiner/Instructor Chief Flight Instructor

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To Whomsoever It May Concern:

GROUND SCHOOL

This is to certify that (Full Name) has received ground instruction covering the FAA syllabus for :

Private Pilot Certificate


Instrument Rating
Commercial Pilot Certificate
Multi Engine Rating

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Chief Flight Instructor

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To Whomsoever It May Concern:

GROUND SCHOOL

This is to certify that (Full Name) has received ground training covering the
technical and performance subjects Cessna 152, Cessna 172 and Beechcraft Duchess 76.

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Chief Flight Instructor

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To Whomsoever It May Concern:

SUMMARY OF INSTRUMENT TIME

This is to certify that (Full Name) has over 5 hrs of Instrument time between 19th June 2008 to 20th
June 2008 meeting the requirements of DGCA for conversion of FAA CPL to Indian CPL.

True Extract from Log Book

DATE AIRCRAFT FROM TO INSTRUMENT


IDENTIFICATION HOURS

19-06-09 CE-152 : NN87262 KABC KABC 01:42 (S)


19-06-09 CE-172 : N123AB KABC KABC 01:18 (S)
19-06-09 CE-172 : N12345 KABC KABC 01:00 (S)
20-06-09 BE-76 : N54321 KDES KDES 01:06 (S)

TOTAL INSTRUMENT TIME:


ACTUAL: 00:00
SIMULATED: 05:06

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To Whomsoever It May Concern:

SUMMARY OF INSTRUMENT TIME

This is to certify that (Full Name) has completed over 40 hrs of Instrument time during his
Commercial Pilot Training at (school name)

True Extract from Log Book


DATE AIRCRAFT FROM TO INSTRUMENT
IDENTIFICATION HOURS

22-09-08 CE-152 : NN5061Q KABC KABC 00:42 (S)


24-09-08 CE-152 : NN5061Q KABC KABC 00:42 (S)
26-09-08 CE-152 : NN5061Q KABC KABC 00:48 (S)
13-10-08 CE-152 : NN87262 KABC KABC 00:30 (S)
19-10-08 CE-152 : NN87262 KABC KABC 00:42 (S)
31-10-08 PCATD : 1234A ------------- 00:30 (S)
01-11-08 PCATD : 1234A ------------- 00:30 (S)
02-11-08 PCATD : 1234A ------------- 00:54 (S)
08-11-08 PCATD : 1234A ------------- 01:18 (S)
12-11-08 PCATD : 1234A ------------- 00:24 (S)
14-11-08 PCATD : 1234A ------------- 00:42 (S)
19-11-08 PCATD : 1234A ------------- 01:24 (S)
23-11-08 PCATD : 1234A ------------- 01:06 (S)
24-11-08 PCATD : 1234A ------------- 01:30 (S)
25-11-08 PCATD : 1234A ------------- 01:24 (S)
26-11-08 PCATD : 1234A ------------- 00:36 (S)
26-11-08 PCATD : 1234A ------------- 01:42 (S)
29-11-08 PCATD : 1234A ------------- 00:30 (S)
30-11-08 PCATD : 1234A ------------- 01:36 (S)
03-12-08 CE-172 : N12345 KABC KABC 01:12 (S)
05-12-08 PCATD : 1234A ------------- 01:24 (S)
06-12-08 CE-172 : N12345 KABC KABC 00:48 (S)
07-12-08 CE-172 : N145ES KABC KABC 00:54 (S)
08-12-08 CE-172 : N145ES KABC KABC 01:00 (S)
13-12-08 CE-172 : N145ES KABC KABC 01:06 (S)
28-12-08 CE-172 : N734LY KABC KABC 00:48 (S)
08-01-09 CE-172 : N12345 KABC KABC 01:30 (S)
10-01-09 CE-172 : N12345 KABC KABC 00:42 (S)
16-01-09 CE-172 : N145ES KABC KABC 00:54 (S)
02-02-09 CE-172 : N12345 KABC KABC 00:42 (S)

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03-02-09 CE-172 : N123AB KABC KABC 00:42 (S)
06-02-09 CE-172 : N123SP KABC KABC 01:18 (S)
09-02-09 CE-172 : N456AB KABC KABC 01:06 (S)
09-02-09 CE-172 : N456AB KABC KABC 00:30 (S)
11-02-09 CE-172 : N123SP KABC KABC 03:00 (A)
14-02-09 CE-172 : N1234 KABC KABC 01:24 (S)
16-02-09 CE-172 : N1234 KABC KGGG 01:30 (A)
16-02-09 CE-172 : N1234 KGGG KABC 02:12 (A)
22-02-09 CE-172 : N1234 KABC KABC 01:00 (S)
25-02-09 PCATD : 1234A ------------- 00:30 (S)
26-02-09 CE-172 : N12345 KABC KABC 01: 18 (S)
16-04-09 BE-76 : N54321 KABC KABC 00:12 (S)
28-04-09 BE-76 : N54321 KABC KABC 00:12 (S)
28-05-09 BE-76 : N54321 KDES KDES 00:06 (S)
29-05-09 PCATD : 1234A ------------- 02:00 (S)
30-05-09 PCATD : 1234A ------------- 00:30 (S)
31-05-09 PCATD : 1234A ------------- 01:00 (S)
19-06-09 CE-152 : NN87262 KABC KABC 01:42 (S)
19-06-09 CE-172 : N123AB KABC KABC 01:18 (S)
19-06-09 CE-172 : N12345 KABC KABC 01:00 (S)
20-06-09 BE-76 : N54321 KDES KDES 01:06 (S)

TOTAL INSTRUMENT TIME


ACTUAL: 06:42
SIMULATED: 46:24

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Pilot under check Chief Flight Instructor

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To Whomsoever It May Concern:

This is to certify that (Full Name) has completed the Pilot proficiency test report for Instrument
Rating carried out by (Instructor Name) (CFI, CFII, MEI) in Beechcraft Duchess : N54321 as per
the DGCA requirements.

True Extract from Log Book

DATE AIRCRAFT FROM TO DURATION APPROACHES


IDENTIFICATION

20th JUN BE-76 : N54321 KDES KDES 01:18 3


2008 (01:06 ILS GPS VOR
Simulated)

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

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To Whomsoever It May Concern:

This is to certify that (Full Name) has completed the Pilot proficiency test report for Instrument
Rating carried out by (Instructor Name) (CFI, CFII, MEI) in Cessna 172 : N12345 as per the
DGCA requirements.

True Extract from Log Book

DATE AIRCRAFT FROM TO DURATION APPROACHES


IDENTIFICATION

19th JUN CE-172 : N12345 KABC KABC 01:06 3


2008 (01:00 ILS GPS VOR
Simulated)

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

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IR TEST REPORT FOR MULTI ENGINE AIRCRAFT
NAME: (Full Name) LIC No: ________ Valid Till: N/A
TEST ON A/C TYPE: BE-76 REGN NO: N54321
th
DATE: 20 June 2008 TIME DAY: 01:18 (including 01:06 simulated instrument)

STAGE EXCERCISE REMARKS

Preflight Preparation Preflight Checks S


Engine Start S
Nav. Aids Selection and ATC Clearance S
Taxing S
Checklist and Briefing S

Departure and Normal Take Off S


En-route Engine Failure after T/O in Stabilized flight S
Area Departure S

Air Work Instrument Failure S


Aircraft Handling S
Engine Shut-Down and Re-Light S

Terminal Approach S
ILS/PAR/ASR/VOR/NDB S
Missed Approach/Reject Landing at 50 S
Landing Asymmetric Landing S
General Crew Co-ordination S

ASSESSMENT- AS: Above Standard S: Standard BS: Below Standard.

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

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IR TEST REPORT FOR SINGLE ENGINE AIRCRAFT
NAME: (Full Name) LIC No: ________ Valid Till: N/A
TEST ON A/C TYPE: CE-172 REGN NO: N12345
th
DATE: 19 June 2008 TIME DAY: 01:06 (including 01:00 simulated instrument)

STAGE EXCERCISE REMARKS

Preflight Preparation Preflight Checks S


Engine Start S
Nav. Aids Selection and ATC Clearance S
Taxing S
Checklist and Briefing S

Departure and Normal Take Off S


En-route Engine Failure after Take Off in Stabilized S
flight
Area Departure S

Air Work Instrument Failure S


Aircraft Handling S
Engine Shut-Down and Re-Light NA
(Feathering/Un-feathering) at or above
5000ft AGL

Terminal Approach S
ILS/PAR/ASR/VOR/NDB S
Missed Approach/Reject Landing at 50 S
Landing Asymmetric Landing NA
General Crew Co-ordination S

FINAL ASSESSMENT: Satisfactory


ASSESSMENT- AS: Above Standard S: Standard BS: Below Standard
LIMITATION: Alt (+/-)100 feet, Hdg (+/-)10 degree, Speed (+/-)10kts except in Approach phase in which case speed
limit would be +10kts & - 0 ft.

Your name Examiner sign Seal and Sign


Pilot under check Approved Examiner/Instructor Chief Flight Instructor

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To Whomsoever It May Concern:

SIGNAL RECEPTION TEST

This is to certify that (Full Name) has been checked by the undersigned for Morse code signal
reception competency check (eight word per minute).

Seal and Sign


Chief Flight Instructor

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