PAKISTAN

CIVIL AVIATION AUTHORITY

APPLICATION FOR ISSUE / RENEWAL /EXTENSION OF
AIRCRAFT MAINTENANCE ENGINEER'S LICENCE /
PC / CONVERSION OF PROFICIENCY CARD /
FOREIGN LICENCE / VALIDATION

CAAF-111-AWXX-4.0

AIRWORTHINESS DIRECTORATE
Purpose for Application:

Issue

Extension

Renewal

Conversion

Validation

Re-Exam
(Written)

Re-Exam
(Oral)

Issue / Extension of AMEL / P.C

Personal Data

To,
The Field Office / Airworthiness Directorate,
Pakistan Civil Aviation Authority (PCAA),
Karachi, Pakistan.
1.
Full Name: FARAZ ALI KHAN
2.
Son of: IMTIAZ ALI KHAN
3.
Nationality: PAKISTANI
4.
C.N.I.C No: 42201-3648194-3
5.
Employer: LUCKY AIR (PVT) LIMITED
6.
Date of Employment: NOVEMBER 26, 2012
7.
Academic Qualification: BE ELECTRONICS
8.
Deployed at / Position held: AVIONICS ENGINEER
9.
Email: faraz.khan@luckyair.com.pk
10.
Date of Birth: JUNE 02, 1982
11. Permanent Address: B-9/3, MALIR EXTENSION COLONY KARACHI - 37
12. Present Address: R-99, PAK KAUSAR TOWN MALIR EXTENSION COLONY KARACHI - 37
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21.

AME Licence No. / Approval / P.C No (if any): HQCAA/2207/8/AW(VoI.IV), HQCAA,2207/8/AW & HQCAA/1041/LWTR-2344/AWEG/2425
Licence Category / Approval / P.C held, (if any): CAT X & CAT R (B2)
Type of Equipment for which you are applying: BOMBARDIER LEARJET 60XR / PRATT & WHITNEY 305A ENGINES
Did you apply for the issuance of a PCAA Licence / P.C in the past:
Yes
No
If Yes, have you given the details in the Self Assessment Form.
Yes
No
I desire to be examined at:
Islamabad
Lahore
Karachi
Experience details for the issue or extension of an AME licence / issue or extension or conversion of PC : 01 YEAR & 04 MONTHS
Last Endorsement obtained and date: NOT APPLICABLE
Enclosures to be attached as applicable (Please tick mark):
AMEL / PC (Original applicable for extension only)

Self Assessment Form

Copy of LWTR

Copy of AMCA / PCCA

Copy of Medical Card

Course Certificates

Evidence of Age

Copy of Academic Qualification

Programmed OJT

03 Photograph (1x1)

Receipt of Fee

Con / Val of Foreign

Licence

(as applicable)

22.
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26.
27.

Schedule of Work

Note All copies are to be attested

Foreign AME Licence No.: NOT APPLICABLE

Categories / sub-categories held: NOT APPLICABLE
Type of Equipment for which you are applying: NOT APPLICABLE
Validity of Foreign AME licence: NOT APPLICABLE
Foreign AME issuing authority and state: NOT APPLICABLE
Enclosures to be attached as applicable (Please tick mark):
Copy of Foreign Licence
Evidence of present employment
in Pakistan relating to the category sough
Copy of Medical Card AMCA

Certificate of Verification from Issuing Authority

Evidence of working on a Pak register aircraft by submitting
the current 03 months work schedule
01 Photograph (1x1)
Receipt of fee

NOT APPLICABLE

Renewal

Note All copies are to be attested

28.

Experience details for renewal of an AME licence / P.C: NOT APPLICABLE

29.

AMEL - Evidence of being engaged in aviation activities as per AWN 34.

AMEL - Evidence of having undergone a refresher course (as applicable) in accordance AWN 34.
PC - Evidence of being engaged in aviation teaching in the last 02 years. NOT APPLICABLE
PC - Evidence of experience as per AWN 34. NOT APPLICABLE
Approximate date of last certification as A.M.E / conducting a class (P.C) : NOT APPLICABLE
Date of expiry of AME licence / P.C:
NOT APPLICABLE
Submitted the AMEL / PC 15 days before expiry:
Yes
No
Enclosures to be attached as applicable (Please tick mark):

30.
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34.
35.

Copy AMEL / PC

Schedule of Work

Copy of Medical Card

Copy of Foreign Licence (if applicable)

01 Photograph (1x1)

Receipt of fee

NOT APPLICABLE

NOT APPLICABLE

NOT APPLICABLE

Note All copies are to be attested

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CAAF-111-AWXX-4.0

FARAZ ALI KHAN

solemnly declare that the information provided and work carried out by me are correct fully
I, Mr.
compile with the requirements given in the current AWN 34.

DECLARATION

If any information provided or work that has been carried out by me, is found to be false or misleading. I shall render myself liable to Part XVIII
Penal Provisions and Prosecutions of the Civil Aviation Rules 1994.
I have completely read and understood Part XVIII (Penal Provisions and Prosecutions) and Part XIX (with Holding, Suspension and Cancellation of
Licences and Certificates) of the Civil Aviation Rules 1994.

Signature of Applicant
Date

Evaluating Office:
Remarks.
Recommendation

FOR USE IN CIVIL AVIATION AUTHORITY

Tick one:

Issue
Extension
Renewal
Conversion
Validation

of

For evaluation of examination application, refer recommendations on the Self Assessment From.
Signature
Designation
Date
Airworthiness HQ:
Remarks.

Signature
Designation
Date

Fee Deduction:

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