CAR 66 ISSUE II R 1

Appendix V –Applications and Formats

CA FORM 19-10: Format of aircraft maintenance engineer work record / log book

FORMAT OF AIRCRAFT MAINTENANCE ENGINEER DGCA INDIA

WORK RECORD / LOG BOOK CA Form 19-10
Affix recent
1. PERSONAL DETAILS
passport size
CEO Computer photo graph
No. duly attested on
the front side
*Name in full

*Date of birth * Nationality

*Educational GENDER M/F AME Licence No.

Qualification

*Permanent Address……………………………………………................………………………………………………………………………
……………………………………………………………………………………………………..……………PIN Code....................................

Changed Permanent Address

*Address for Communication (if different from above)………………………...........................................................

………………………………………………………………………………………………………………..….PIN Code...................................

Changed Address for Communication:

Applicant Contact Phone Number ………………………….............. E-mail…….………………………………..……………….

Name of the Current Employer……………………………………………………………………………………………………………….

Contact Phone Number of Employer ………………….................... E-mail…….…………………………………………………

Log Book Owners Name…………………………………………………………….... Signature ………………………………………..

2. Record of Training:

Training
Training Completed Establishment and From To Result
Location
3. (i) Details of Employer / Organisation at which engaged in Aircraft Maintenance

Employer / Organisation:

FROM To Position Nature of Work

Types of Aircraft or other products

Confirmation of the Organisation

NAME SIGNATURE POSITION & STAMP DATE

3 (ii). Details of Employer / Organisation at which engaged in Aircraft Maintenance

Employer / Organisation:

FROM To Position Nature of Work

Types of Aircraft or other products

Confirmation of the Organisation

NAME SIGNATURE POSITION & STAMP DATE

3 (iii) . Details of Employer / Organisation at which engaged in Aircraft Maintenance

Employer / Organisation:

FROM To Position Nature of Work

Types of Aircraft or other products

Confirmation of the Organisation

NAME SIGNATURE POSITION & STAMP DATE

4.BASIC SKILL
Supervisor
Aircraft Reg.
*Typical Maintenance Tasks CATEGOR Date on which Organization Name and
No & Type
(1) Y performed (3) (4) AME
(2)
Licence No.
Time limit/ Maintenance

LV .Accessory Gear Box

c. *Check Chip detector

All the applicable aircraft maintenance tasks listed under Appendix II to AMC of CAR-66 should be reproduced
under column (1).
Details of tasks performed should be furnished under column 2, 3, 4 and 5
Maintenance tasks not performed should be indicated as “ NOT PERFORMED”
5.*DECLARATION

I hereby confirm that the information contained in this form was correct at the time of application.

PLACE SIGNATURE

DATE NAME
It is an offence to make, with intent to deceive, any false representations for the purpose of procuring the
grant, issue, renewal or variation of any certificate, licence, approval, permission or other document. Persons
doing so render themselves liable to administrative/legal actions as per Aircraft Rules 1937. Further the licence
is liable for revocation / cancellation / suspension or permanently makes the person ineligible to have an
Aircraft Maintenance Engineer’s Licence.