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Appendix IV — EASA Form 12

ED Decision 2020/002/R

EASA FORM 12

Page 1

APPLICATION FOR PART-147

INITIAL / CHANGE OF APPROVAL

Registered Name & Address of Applicant:

Trading Name (if different):

Addresses Requiring Approval:

Tel No:....................................Fax No..................................E Mail.........................................

Scope of Part-147 Approval Relevant to This Initial */ Change of * Application

(See other side for training course designators to be used):

Basic Training:

Type Training:

Provide reference to other approvals under the Basic Regulation:

* Cross out whichever is not applicable

Name & Position of Accountable Manager:

Signature of Accountable Manager:

Date of Application:

Please send this form with any required fee to be paid

under National Legislation to your National Aviation Authority

Space for official use