REPÚBLICA DE GUINEA ECUATORIAL

DIRECCIÓN GENERAL DE AVIACIÓN CIVIL

OPERATIONAL SAFETY SECTION DGAC/LIC/00
LICENSES AND OPERATIONS SUBSECTION 1a
Ing
LICENSE CONVALIDATION REQUEST
AIR TRANSPORTATION PILOT LICENSE
A APPLICANT PERSONAL DATA
1 1.a Given 1.b Family
Name Name
2 2.a Birth 2.b Nationality
Date
3 Gender: Male: Femal
e:
4 Marital Married: Single
Status: :
5 5.a High (m) 5.b Weight
(kg)
6 6.a Hair 6.b Eyes color
Color
7 Address
(birthplace)
8 Address
(Equatorial
Guinea)
Note: Any change in any of the above data shall be immediately communicated to
the DGAC
B Licenses, Habilitations and Qualifications
License Type Reference Expedition Date Expiration Issue
Number Date Country

Habilitations Reference Expedition Date Expiration Issue

Number Date Country

Recent Last Flight Aircraft Company

Experience

C Necessary Documents for the process

Shall be annexed to this request:
1 Letter from the Equatoguinean employee company, detailing the period of the
contract and the applicant job at the employee.
2 License, Habilitations and Qualifications Documents, originals and copy (or 2
authenticated copies)
3 Applicant Flight Hours Databook , original and copy (or 2 authenticated
copies)
4 Adequate and Valid Medical Certificate, signed by Aeronautical Medic, original
and copy (or 2 authenticated copies)
5 2 passport or “carnet” size color photographs
6 Copies from the last simulator qualification check, if applicable for the aircraft
type
7 Copies of the Attendance Certificates for the applicant’s last qualification
course, based on approved Operational Training Program, also to be presented
D License Class
I’m aware that, during operations within the Equatorial Guinea Territory or under
Equatoguinean Air Operators, I shall work only as authorized by the Convalidation
Authorization issued by the Civil Aviation Authority of Equatorial Guinea; and
I’m aware that the Civil Aviation Authority of Equatorial Guinea may issue a
Convalidation Authorization more restrictive than my original license, based on a
Qualification Analysis.

Date Applicant Signature

 DGAC/LIC/001/Ing
E FOR DGAC EXCLUSIVE USE
LICENCIAS Y EXPERIENCIAS FECHA OBSERVACIONES
LIMITACIONES REQUERIDAS

Licencia Número Fecha Expedición Fecha Expiración

Revisado por:
en
Fecha
Jefe del Negociado de Operaciones y Licencias

Aprueba :
en
Fecha
Jefe de la Sección de Seguridad Operacional