Form6: ATPL Distance Learning Application

ATPL Distance Learning Application

Fill out the form carefully for registration
Applicant Name*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Address*

Street Address Line1

Street Address Line 2

CityCountry

Post Code
Phone Number*

Country CodePhone Number
Email*
Nationality*
Passport Number*
Passport Expiry*

DayMonthYear
Emergency Contact*
Emergency Contact Number*

Country CodePhone Number
Please confirm that you are holding a Class 1 Medical Certificate*
Please confirm that you can travel to an IAA exam centre to complete examinations*
Please confirm that you are holding an ICAO PPL*
Is English your first language?*
If no, what level?
Have you ever been convicted of a criminal offence? *
Education
Secondary School*
Address*
From*

DayMonthYear
To*

DayMonthYear
Did you graduate?*
Certificate Achieved*
College/University
Address
From

DayMonthYear
To

DayMonthYear
Did you graduate?
Qualification Achieved
How often do you intend to train?*
If other, how often?
If any, write your pilot training experience here*
Candidate Declaration*

I hereby certify that all information I have given in this application, along with any supporting documentation, is correct and that no relevant information has been withheld. I understand that any deposit paid is non-refundable. To commence the course, it is a requirement that each Candidate holds an ICAO PPL, a Class 1 Medical and can travel to an IAA examination centre.
Signed Date*

DayMonthYear
‍We need you to provide the following along with this Application :
1.Photocopy or scanned image of your Passport or Drivers Licence*

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2.Photocopy or scanned image of your Private Pilots Licence*

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3.Photocopy or scanned image of your EASA Class 1 Medical Certificate or confirmation of date to attend Class 1 Medical Examination

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Should be Empty: