MINISTRY OF TRANSPORTATION DIRECTORATE GENERAL OF CIVIL AVIATION. DIRECTORATE OF AIRWORTHINESS AND AIRCRAFT OPERATION ‘Kary Building, 22/F., J, Merdeka Borat “axaria 10710 - Indonesia No, ‘hone: (622i) 9806664 s80668 Fac (62-21) 3608063, Webster Sophub gee eral fight eperaionGeakcephvb gold AE OF OE AIRMEN PROFICIENCY/QUALIFICATION CHECK Ftly, Hr OVP NAME OF AIRMAN GENCE NUMBER TYPE OF CHECK ARWIRO BULFARAR F 16 - ©6324 IR EMPLOYED BY BASEAT TYPE OF AIRCRAFT BPS BANYULANC Ganyowantcr SMULITORUEED | co ANE OF CHECK AIRMAN TOANUMBER BLOCK TIME CAPT. REYmON Pp Ol. 30 FLIGHT WANOEUVRES GRADE (SSatieactory UUnentfacion) wor = i NNER TE aE PaERLGHT ESPEN COUNTING wT [7_EQUIPRENT EXAMINATION (Oral or wtien) = ZPREFLIGHT CHECK OF AIRCRAFT. re PREFLIGHT INSPECTION 5 S-GOMPUTATION OF FUEL LOAD FUEL TONONIG [fC proceoune 4 STARING. z “Z_COMPLETION OF COMPANY APPROVED FORNS, Tt LE PoWERPONT ORO = STARING. TAK AND RON UP 7 TREOS &- PER PAT AND PROPELLER CONTR t SORA yo “T-GRUTSE CONTROL AND COMPUTATUONS + [enero i 7 ARGRAFPROWERPANT OPERATION NATE [7 CROSSWiND | = ‘FUEL SYSTEM MANAGEMENT wr sau TED POWERANT A ORE Ta-AI CONDITION PE SEUNTATON CORTROL aekcreD wor Ti ELECTRON 4VETEN GPETATON SO WROSHENR wel TE POWERPLANT FRE CONTROL ROME PROSTORES TH EMERGENCY GEA AND FAP EXTENSION fn t TE HERTER FRE SD CARDS COMPURTMENT FRE =i. TS SMOKE EVACUATION r Ti EMERGENCY DePRESTOREATON fr TT-FUELDUMPRG PROCEDURES F = TE POWEARLANT STSOMN AO RESTART Fr T-pEICnG AND ANTICING rns Zs Bt LOCATION AND USE OF SHERGERCY EGUPENT Hamas oh {EMERGENCIES HYSRAUIS PRESSURE ET CREW CORONATION AO HORTTORN i A ShooderS Rechormon ce Rese for \EG Ae aernoveo arsracton oe CHECK AIRMAN PERFORMANCE oF DISAPPROVED UNSATISFACTORY ANE WEPECTOR WEPECTON “ee, 4 10 ‘DAC FORM 61-6 cart. FAYMONDINSTRUCTOR'S RECOMMENDATION: = aera ph ope S SE MS Instructor's Name & Signature / LOA no. Licance / LOA expires TART = Bupt Fan [ea Races A (f= Y - 2orF | Pi RECOMMENDATION ‘ Lacendnpayeinnen bit neato ‘course, and is pertinent requremenis of CASR 61 forthe plot icence or rating sought. {_} have personaly renewed this applicants graduation certificate, and fourd it tobe appropiate and in oder, and have returned the cacao. {have personaly desired andlor verled this application in aocordanca wih pertinent procedures and standard wih the recut indicated below. | 1Approved {1 Disapproved -Disapproval Notice issued (Copy Altached) Evalue recor Arie Transport Meme ecor Bain | Oral {1 1) | Approved simulatorfiraining device check t 1) Aircraft fight check a i) DGCA INSPECTOR’S REPORT | have personaly tested this applicant in accordance with or have olherwse verified thal hs applicant complies with pertnent procedures, standards, plies and or necessary requirements wit the result indicated below. proves {1 saproved-Disapproal Note Iesues DAG Form 61-1 (7-02) Page 2 of2S161-01 MINISTRY OF TRANSPORTATION DIRECTORATE GENERAL OF CIVIL AVIATION DIRECTORATE OF AIRWORTHINESS AND AIRCRAFT OPERATION Karya Building, 22/F., JI. Merdeka Barat No. 8 Jakarta 10110 - Indonesia Phone: (62-21) 3506664, 3506665 Fax: (62-21) 3506663 Website: www.dephub.go.id email: flight_operation_dac&dephub.go.id I. FEELCRTION INFORMATION [Mlnstrument [ 1¢ider {1 Ground instructor f Ist" [| editonal Aircraft Rating {_]Ughterthan-Air {_ ] Medical Fight Test Private Airplane Single-Engine {Flight instuctor_ inal _ Renewal {| Reexamination L_} Commercia {| Aiplane Mutiengine {_] Fight instructor Reinstatement { }Reissuance of cence {_1Airtine Transpor [_Rotororat {_}Addiional instructor Ratg [JOther — IA. Name (First, Middle, Last B Diyas ©, Date of ith D. Place of Bith ARWIRO ZULFARAR FIITRI 46 - 0634 | 16 - 03 - !995 UIUNG _PANOANG E Aas ee F Nationality Specty G Doyou read, speak and understand English? “ "AT! REHUTAVAN Toerren ii [Mindonesian [ 10ther [1Yes [ ]No [Siren eco H Height me J Heir K Eyes U Sex IDOARTO , TAWA TiMuR , 61253 o Buacie Black MALE IM. Do you now hold or tyes es ere | yee Date]N. Grade Piot Licence ['0. LicenceNo. | P. Dale Issued have your ever held _[W/Yes | been suspended or revoked ‘a DGCA Pilot Licence? [_]No I9- (2 - 2016 IM--Do you hold or Nes | Vincle operation involving alcohol related offenses? Rr Cass of Corcate 3. Date i000 T. Name of Examiner Medical Cerificate? | ]No FIRST 2B 201 dr. ERM\ watryu HARYANI 1U. Have you ever teen convicted for violation of any laws pertaining to V. Date of Final Conviction Narcotic drugs, marjuana, and depressant or stimulant drugs or substances, ormotor [No [ Tes Glider or free balloon Pilots only: kes me unable to pilot a glider or free Medical Sialoment Ihave no known physical defect which mah balloon We Signature X Date ll. LICENCE OR RATING APPLIED FOR ON BASIS OF: IC_ TA. Completion of required test 7, Arraf to be used i ight test required) [ 18. Miltary compelence dotained in 3. Pic/siC IC. Graduate of approved course | 1. Name and location of traning shcoo! BP3 2a. Total ine tis arora 25. Plot command hours Date rated Has flown atleast 10 hours as plot in command during the past 12 months in the following military aircraft. side eanytunnier |* Se Nunbe 1Al - 014 Date Grade oience py, + Rats SMGLE ENGIVE PAST 30 DAYS? | ives NG are true. DAC Form 61-1 (7-02) B. Dale 0g = 02.- 200 Page 1 of 2