CHANGE OF RVSM APPROVAL STATUS _____________________________________________________________

Please complete this form to inform the RVSM Programme when the pilot reports a change in the RVSM approval status of the flight. The RVSM Programme will then be able to confirm the RVSM status of the Operator / Aircraft Type and if required, take appropriate action. Notes on the completion of this form are on the reverse side. When complete send to: EUROCONTROL DAS/AFN USER SUPPORT CELL Rue de la Fuse, 96 B-1130 Brussels BELGIUM

E-mail: EurRMA.support@eurocontrol.int Fax: +32 2 729 4634

SECTION A
1. Name of ACC 2. Name / Designator of Sector 3. Date / Time of Occurrence 4. Tel No / Fax / Email (if response required)

SECTION B
Please complete as much of this section as possible
5. Call Sign: 6. Designator / Name of Operator 8. Aerodrome of Departure / Destination 9. Pilots Request (Tick as appropriate) 7. Type of Aircraft

Change from NEGATIVE RVSM TO RVSM APPROVED Change from RVSM APPROVED TO NEGATIVE RVSM

10. Why did the pilot report change to the RVSM approval status?

11. Did the Pilots Request to change RVSM approval status occur when the aircraft was OUTSIDE or INSIDE RVSM airspace? (Tick as appropriate) OUTSIDE INSIDE

12. Action taken by controller

13. Attach copy of FLIGHT PLAN if possible: (Flight Plan attached?)

YES

NO

CHANGE OF RVSM APPROVAL STATUS _____________________________________________________________

Notes on completion of the Change of RVSM approval status Form This form should be completed whenever a pilot has reported a change of RVSM approval status during flight. This is valid when a pilot requests ATC to modify the Flight Plan (FPL) from non-RVSM approved to RVSM approved and also if the pilot reports NEGATIVE RVSM when the flight plan indicates a W in Field 10. The Form is divided into two sections. The first section identifies the reporting unit and is self explanatory. The second section deals with the information required to identify the aircraft concerned and what has led to the change of RVSM status. As much information as possible should be included in this section to help EUROCONTROL to follow this up and take appropriate action. Boxes 1 4 Box 5 Box 6 Box 7 Box 8 Box 9 Box 10 Self Explanatory. Insert Call Sign assigned to Flight. Insert Designator of Operator. (if different from Call Sign as indicated in Field 18) Insert Type of Aircraft. Insert Aerodrome of Departure and Destination. Mark appropriate box to indicate type of request made by pilot. State reason why pilot reported to ATC the change in RVSM status (e.g. in response to a question from ATC, refusal of access to RVSM airspace, etc.). State if aircraft was operating inside or outside RVSM airspace at the time the pilot reported the change of RVSM approval status to ATC. Insert action taken by controller. State whether FPL is attached and attach copy of IFPS FPL or system flight plan, if possible.

Box 11 Box 12 Box 13