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540 License Validation or Conversion Application Form
CAAP application form for license validation and foreign license conversion
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: APPLICATION FOR
LICENSE VALIDATION OR CONVERSION
BASED ON A FOREIGN LICENSE
INSTRUCTIONS
Print or type. Do not write in shaded areas, these are for
CAAP use only. Submit original only to the Flight Standards
Inspectorate or a CAAP Authorized Person. If additional
space is required, use an attachment
A. APPLICATION IS HEREBY MADE FOR ISSUANCE OF A PHILIPPINES LICENSE BASED ON VALIDATION OR CONVERSION OF A FOREIGN LICENSE:
1
ADDED RATING
4
MEDICAL CERTIFICATE
7
FLIGHT INSTRUCTOR
2
PILOT
5
AVIATION MAINTENANCE TECHNICIAN
8
FLIGHT DISPATCHER
3
FLIGHT ENGINEER
6
INSPECTION AUTHORIZATION
9
FLIGHT NAVIGATOR
B. AIRMAN PERSONAL INFORMATION:
1. NAME (Last, First, Middle)
2. PERMANENT ADDRESS (Street or PO Box Number)
3. TELEPHONE AND FAX
4. CITY
5. DATE OF BIRTH (MONTH, DAY, YEAR)
9. HEIGHT
10. WEIGHT
11. HAIR
6. PLACE OF BIRTH
12. EYES
13. SEX
/STATE/PROVINCE
MAIL CODE
7. NATIONALITY (CITIZENSHIP)
COUNTRY
8. LANGUAGE
PROFICIENCY
LEVEL 4?
14. E-MAIL ADDRESS
Yes
No
15. For CAAP Use
C. PILOT INFORMATION:
1. LICENSE NUMBER
2. STATE OF ISSUE
5. TOTAL FLIGHT HRS
6. TOTAL PIC HRS
3. DATE ISSUED
7. TOTAL X-C HRS
4. RATING(S) REQUESTED
8. TOTAL NIGHT HRS
9. INSTRUMENT PIC
11. RATINGS AND LIMITATIONS TO BE ISSUED
10. TOTAL HRS TYPE
12. ASSIGNED NUMBER AND EXPIRATION DATE
D. OTHER LICENSE INFORMATION:
1. LICENSE NUMBER
2. STATE OF ISSUE
3. DATE ISSUED
4. RATING(S) REQUESTED
5. RATINGS AND LIMITATIONS TO BE ISSUED
6. ASSIGNED NUMBER AND EXPIRATION DATE
E. MEDICAL EVALUATION INFORMATION:
1. CLASS OF CERTIFICATE
2. STATE OF ISSUE
3. DATE OF ISSUE
4.MEDICAL EXAMINER
G. ATTACH APPLICANT PHOTO HERE
(Passport Size)
5. LIMITATIONS OR RESTRICTIONS TO BE ISSUED
6. ASSIGNED NUMBER AND EXPIRATION DATE
F. APPLICANT’S CERTIFICATION— I certify that all statements and answers provided by me on this application form are complete and true to the
best of my knowledge and I agree that they are to be considered as part of the basis for issuance of any Philippines license to me.
A person shall not with intent to deceive: (c) make
1. DATE
2. APPLICANT SIGNATURE:
any false representation for the purpose of
procuring for himself or any other person the
grant, issue, renewal or variation of any such
license...
H. CAAP AUTHORIZED PERSON CERTIFICATION:
1. LANGUAGE PROFICIENCY TEST ADMINISTERED
2. RECOMMEND ISSUANCE OF LICENSE
4. DATE
5. TITLE OR DESIGNATION NUMBER
Copies of all issued Philippines
license(s) attached
Copy of other State's airman
license(s) attached
CAAP Form 540 [0]2011
Copy of other State's medical
evaluation attached
Airman logbook reviewed for
experience requirements
3. CONFIRMATION CONTACT MADE WITH ISSUING CIVIL AVIATION AUTHORITY
TELEPHONE:____________________
NAME: _______________________________ .
ICAO CONTRACTING STATE: ______________________________________________
.
6. SIGNATURE
7. CASORT ENTRY:
Last 12 months experience reviewed
(required for Inspection Authorization)
Copy of aircraft lease reviewed for
applicable time period
Copy of applicable aircraft-specific training
or experience attached
Other relevant experience or training
documents attached
Control Number:
