Application for PART-66 Aircraft Maintenance Licence

Written Examination
Please complete this form online (preferred method) then print, sign and submit as instructed.
Alternatively, print, then complete in BLOCK CAPITALS using black or dark blue ink.

Unique Corporate No. (to be completed by CAA)

FALSE REPRESENTATION STATEMENT

It is an offence under Article 231 of the Air Navigation Order 2009 to make, with intent to deceive, any false
representation for the purpose of procuring the grant, issue, renewal or variation of any certificate, licence, approval,
permission or other document. This offence is punishable on summary conviction by a fine up to 5000, and on
conviction on indictment with an unlimited fine or up to two years imprisonment or both.
1. APPLICANT DETAILS

(The Applicant is responsible for payment of CAA charges)

To be completed by the Applicant

CAA Personal reference number (if known):

Examination reference (if known):

9/93/

Title: ............... Forename(s):.................................................................................................................................................

Surname: ................................................................................................................................................................................
Date of birth (dd/mm/yyyy):..................................................

Nationality: ..........................................................................

Town of birth: ..................................................................................

Country of birth: ..............................................................................

Permanent address: ......................................................................................................................................................................................

.........................................................................................................................................................
Telephone: ......................................................................................

Postcode: ......................................

Mobile Telephone: .........................................................................

E mail address: .......................................................................................................................................................................

A certified copy of your valid passport (see Guidance Note 1) must accompany your initial application as proof of
identification.
2. ADDRESS FOR CORRESPONDENCE (if different from above)

To be completed by the Applicant

Postal Address: .............................................................................................................................................................................................

.........................................................................................................................................................

3. EXAMINATION DATE AND VENUE

Postcode .......................................

To be completed by the Applicant

The available examination centres for the Part-66 Aircraft Maintenance examinations are: *Gatwick, Glasgow, Manchester, Oxford, and
Shuttleworth. Click on link to www.caa.co.uk/Examinations for details of examination dates and venues. A booking confirmation will be
emailed, or posted if no email address provided.
Exam Date ...................................................................................

* Note Gatwick is a 1315 hrs start.

First choice of venue ....................................................................

am - 0900 hrs start

pm - 1300 hrs start *

Second choice of venue ...............................................................

am - 0900 hrs start

pm - 1300 hrs start *

4. CATEGORY/SUB-CATEGORY OF EXAMINATION (tick appropriate box(es))

Category

Aeroplane Turbine

A1

B1-1

Aeroplane Piston

A2

B1-2

Helicopter Turbine

A3

B1-3

Helicopter Piston

A4

B1-4

Avionic

B2

Aeroplane Piston 2000kg and below

B3

Form SRG 1002 (EASA Form 19E UK Version) Issue 12

To be completed by the Applicant

Page 1 of 3

5. CAA USE ONLY

Date
Amount

Cash

Mastercard

Visa

Cheque

Postal Order

Other

6. ADDITIONAL INFORMATION

To be completed by the Applicant

I am applying to take examinations to remove limitations from my Part-66 Licence Category

I hold a Part-66 licence in a different category to the examinations for which I am applying

7. EXAMINATION papers (Please tick box(es) against the module(s) you wish to take at this examination)
To be completed by the Applicant
Module

CAA Use Only

Paper No.

Module

Time

Paper No.

1.

Mathematics

11.

2.

Physics

12. Helicopter Aerodynamics

Structures and Systems

3.

Electrical Fundamentals

13. Aircraft Aerodynamics

Structures and Systems

4.

Electronic Fundamentals

14. Propulsion

5.

Digital Techniques/Electronic
Instrument Systems

15. Gas Turbine Engine

6.

Materials and Hardware

16. Piston Engine

7.

Maintenance Practices

17.

8.

Basic Aerodynamics

Essay Module 7
Maintenance Practices

9.

Human Factors

Essay Module 9
Human Factors

10. Aviation Legislation

CAA Use Only

Time

Aeroplane Aerodynamics,
Structures and Systems

Propeller

Essay Module 10
Aviation Legislation

8. DECLARATION (tick as appropriate)

To be completed by the Applicant

I declare that the information provided on this form is correct.

I declare that I have not taken the above module exams within the last 90 days.
I confirm that I comply with the regulation Part-66 Appendix II 1.B (the maximum number of consecutive attempts for each module is 3.
Further sets of 3 attempts are allowed with a 1 year period between sets. Any candidates first sitting of a module as of 1st August 2012
will be considered the first attempt of a new set of 3).
Signature .........................................................................................

Date ...............................................................................................

PLEASE REFER TO FALSE REPRESENTATION STATEMENT ON PAGE 1

9. SUBMISSION INSTRUCTIONS
Send your completed application form to:
Civil Aviation Authority, Licensing and Training Standards, Examination Section, Aviation House, Gatwick Airport South, West Sussex,
RH6 0YR, United Kingdom
Together with:

a copy of your passport which has been certified as a true copy by a Quality Manager or similar if this is your FIRST application for
CAA Part-66 examinations (Refer to Guidance Note 1 for further details).

Form SRG 1002 (EASA Form 19E UK Version) Issue 12

Page 2 of 3

10. PAYMENT DETAILS

a)

Payment type

Visa

(please tick your chosen method of payment).

Mastercard

Debit Card

Cheque/Bankers Draft

Electronic Transfer

Cash
(max. 200)

We do not accept American Express, Diners Club or JCB cards. Please do not send cash by post.
b)

Bank Details (for payment by Cheque/Bankers Draft)

Cheques or Postal Orders should be made payable to 'Civil Aviation Authority'.

Please write the CAA Application Form No. on the reverse of your cheque.
Please note that any refund applicable will be paid directly to the bank account stated below by BACS transfer.
Name in which Bank Account held: ..................................................................................................................................
Account Number: ..................................................................................

Sort Code: .......................

If overseas:

Swift Code: ..................................................

c)

IBAN Number: .................................................................

CAA Bank Account Details (if paying by Electronic Transfer)

National Westminster Bank plc

Bloomsbury Parrs Branch
PO Box 158
214 High Holborn
London
WC1V 7BX

Account Name: Civil Aviation Authority

Account Number: 36029769
Sort Code: 60-30-06
Swift Code: NWBK GB 2L
IBAN: GB90 NWBK 6030 0636 0297 69

Please supply the following information:

Amount: ..............................................

BACS/CHAPS Reference*: .................................................................

* When making an electronic transfer please instruct your bankers to quote the CAA Application Form number
followed by the application date in the description field (i.e. Form SRG 1002ddmmyyyy).
Payer: ..............................................................................
d)

Date of Transfer: ..................................................................

Card Details (for payment by Credit/Debit Card)

Card number:
Expiry date:

Security Code (last 3 digits on signature strip on reverse of card)

Debit cards only:

Start date:
Issue No:

Amount: ....................................

/
(if applicable)

Name (as written on card): ................................................................................................................................................

(BLOCK CAPS)

Full postal address of card holder: .....................................................................................................................................

......................................................................................................................................

Postcode: .................................

Card holders signature: ...............................................................................................

Please tick box if paying with Company Card

Company Name: ............................................................................

This information is provided at the applicants risk and will be used by the CAA for this payment only and will not
be used for any other purpose.

Form SRG 1002 (EASA Form 19E UK Version) Issue 12

Page 3 of 3

Application for PART-66 Aircraft Maintenance Licence Written Examination

Guidance Notes
GUIDANCE NOTE 1: Certifiers of Documents
The following people can act as certifiers:
1)

Head of a Part-147 Approved Training Organisation or the Head of or Quality Manager or senior person within the Quality Department
of a Part-145 or Part-M Maintenance Organisation.

Instructions for the certifier of your documents are as follows:

1)

Annotate on the copy of the documents to be enclosed with the application: I have seen the original document and I certify that this is
a complete and accurate copy of the original.

2)

Annotate signature and date.

3)

Certifiers name must be written/printed in block capitals.

4) Must include position or capacity, e.g. Head of a Part-147 Approved Training Organisation or Head of or senior person within the Quality
Department of a Part-145 or Part-M Maintenance Organisation.
GUIDANCE NOTE 2
1)

Use this form to apply to sit any of the following:

Part66 written modular examination papers
Part66 essay examination papers

2)

You should read the requirements of Part-66 before completing this form. Information on the Part-66 licence and examinations is
available on our web site www.caa.co.uk.

3)

Examination bookings cannot be amended within 15 clear working days before the examination. Cancellations will only be accepted if
received in writing at least 15 working days before the examination. Refund of examination fees for emergency cancellations or non
attendance will only be given if a valid medical certificate is provided, together with a letter of explanation.
For further information please go to our web site at www.caa.co.uk/examinations.

4)

An administration fee is payable for cancellation or amendment of an examination booking, where the cancellation/amendment is at the
request of the applicant.

Section 8 - Declaration
As per section 8.
FAILURE TO COMPLY WITH THE ABOVE WILL RESULT IN YOUR APPLICATION BEING RETURNED.

Form SRG 1002 Issue 12 Guidance Notes

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