Pulse Form

Special Flight Permit Application

Aircraft Registration Number (xx-xxxx) *

Aircraft Identification

Make*

Model*

Aircraft Serial Number*

Details of Applicant

Full name of applicant*

Member number*

Purpose for Special Flight Permit

Tick relevant box

Ferry for Repairs, Maintenance, Storage

Evacuating aircraft

MARAP Flight Test

State of Emergency

Proposed Itinerary for Purpose

From (place)*

To (place)*

Period for which special flight permit requested (date from - to)*

Other details required for the issue of the Permit

Pilot in command for flight*

Ways, if any, in which the aircraft does not comply with the applicable airworthiness standards. (eg. major defects, damage, unapproved modifications, outstanding service bulletins etc)*

Has any change affected aircraft weight and balance?�*

Restrictions considered necessary by the applicant for safe operation of the aircraft

Other information - Aircraft condition

If the aircraft has been stored, has it been stored

Has the maintenance release/ record expired?

If yes. For how long? (hours, date)

For what reason did the Maintenance Release/ Record expire?

When was the aircraft last flown? (provide date)

When was the engine last run? (provide date)

Document uploads

Upload last copy of maintenance release/ record

Upload copy of last entry made in the aircraft maintenance logbook

Upload image displaying entire aircraft with registration marking visible

Applicant declaration

Declaration

I certify that this application is being made by the nominated registrant

I certify that this application is being made by an agent appointed by the nominated registrant

Full name of person making declaration