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Please complete this form to inform the RVSM Programme when the pilot reports a change in the RVSM approval status of the flight. The RVSM Programme will then be able to confirm the RVSM status of the Operator / Aircraft Type and if required, take appropriate action. Notes on the completion of this form are on the reverse side. When complete send to: EUROCONTROL DAS/AFN USER SUPPORT CELL Rue de la Fuse, 96 B-1130 Brussels BELGIUM
SECTION A
1. Name of ACC 2. Name / Designator of Sector 3. Date / Time of Occurrence 4. Tel No / Fax / Email (if response required)
SECTION B
Please complete as much of this section as possible
5. Call Sign: 6. Designator / Name of Operator 8. Aerodrome of Departure / Destination 9. Pilots Request (Tick as appropriate) 7. Type of Aircraft
Change from NEGATIVE RVSM TO RVSM APPROVED Change from RVSM APPROVED TO NEGATIVE RVSM
10. Why did the pilot report change to the RVSM approval status?
11. Did the Pilots Request to change RVSM approval status occur when the aircraft was OUTSIDE or INSIDE RVSM airspace? (Tick as appropriate) OUTSIDE INSIDE
YES
NO