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    Form 1123 Application Form RVSM Spa

    Uploaded by

    Pero Peric
    This application form is for operators seeking approval from the Belgian Civil Aviation Authority to conduct reduced vertical separation minimum (RVSM) operations. The operator must provide details about their company, aircraft, RVSM procedures and training programs, crew experience, and RVSM equipment. They must confirm they have obtained the necessary RVSM airworthiness approval and established procedures for height monitoring and error reporting. Approval is valid for a specified period and certain documents must be attached including aircraft documents and manuals outlining RVSM procedures.

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    © All Rights Reserved
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    Form 1123 Application Form RVSM Spa

    Uploaded by

    Pero Peric
    92 views3 pages
    This application form is for operators seeking approval from the Belgian Civil Aviation Authority to conduct reduced vertical separation minimum (RVSM) operations. The operator must provide details about their company, aircraft, RVSM procedures and training programs, crew experience, and RVSM equipment. They must confirm they have obtained the necessary RVSM airworthiness approval and established procedures for height monitoring and error reporting. Approval is valid for a specified period and certain documents must be attached including aircraft documents and manuals outlining RVSM procedures.

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    Form 1123 Application Form Rvsm Spa

    Original Title

    Form 1123 Application Form Rvsm Spa

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    This application form is for operators seeking approval from the Belgian Civil Aviation Authority to conduct reduced vertical separation minimum (RVSM) operations. The operator must provide details about their company, aircraft, RVSM procedures and training programs, crew experience, and RVSM equipment. They must confirm they have obtained the necessary RVSM airworthiness approval and established procedures for height monitoring and error reporting. Approval is valid for a specified period and certain documents must be attached including aircraft documents and manuals outlining RVSM procedures.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    92 views3 pages

    Form 1123 Application Form RVSM Spa

    Uploaded by

    Pero Peric
    This application form is for operators seeking approval from the Belgian Civil Aviation Authority to conduct reduced vertical separation minimum (RVSM) operations. The operator must provide details about their company, aircraft, RVSM procedures and training programs, crew experience, and RVSM equipment. They must confirm they have obtained the necessary RVSM airworthiness approval and established procedures for height monitoring and error reporting. Approval is valid for a specified period and certain documents must be attached including aircraft documents and manuals outlining RVSM procedures.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    Federal Public Service Mobility and Transport

    Belgian Civil Aviation Authority


    Operations Directorate

    RVSM APPLICATION FORM (one per a/c)1


    This application form shall be in possession of the Belgian CAA at least 28 days before the intended date of
    beginning of the planned operations2.

    I. Operator

    Operator official name :


    Address (registered office) :
    Post code and Town :
    Telephone number :
    Responsible manager :
    E-mail address :
    Type(s) of operation : (mark the used type(s) of operation in the tick boxes below)
    ☐ CAT ☐ NCC ☐ NCO ☐ SPO

    Give types of specialised operations (SPO), if applicable :

    II. Aircraft

    Aircraft Registration :
    Aircraft Type :
    Aircraft Mark/Series :
    Manufacturers Serial/Construction N° :
    Aircraft Mode S Address Code (hexadecimal) :
    Date Airworthiness Approval Issued :
    Area of Operation (as specified in ICAO Doc 7030) where RVSM Approval has been issued :
    (mark the used FIRs in the tick boxes below)
    ☐ EUR ☐ AFI ☐ MID / ASIA ☐ NAT ☐ NAM ☐ CAR ☐ SAM ☐ PAC

    Expiry Date of requested RVSM


    Approval (if applicable or required) :
    Remarks :

    OPS Procedures Form 1123 issue 08/03/2017 page 1/3


    Federal Public Service Mobility and Transport
    Belgian Civil Aviation Authority
    Operations Directorate

    III. RVSM Operations


    Details & Evidence Yes Document No
    Reference
    The RVSM airworthiness approval has been obtained. ☐ ☐
    Procedures for monitoring and reporting height-keeping errors have
    ☐ ☐
    been established.
    A training programme for the flight crew members involved in these
    ☐ ☐
    operations has been established.
    Operating procedures have been established specifying :
    (1) the equipment to be carried, including its operating limitations and ☐ ☐
    appropriate entries in the MEL;
    (2) flight crew composition and experience requirements; ☐ ☐
    (3) flight planning; ☐ ☐
    (4) pre-flight procedures; ☐ ☐
    (5) procedures prior to RVSM airspace entry; ☐ ☐
    (6) in-flight procedures; ☐ ☐
    (7) post-flight procedures; ☐ ☐
    (8) incident reporting; ☐ ☐
    (9) specific regional operating procedures. ☐ ☐
    In accordance with Commission Regulation (EC) No 965/2012 on Air operations, Annex V Part-SPA,
    Subpart D – Operations in Airspace with Reduced Vertical Separation Minima (RVSM).

    IV. RVSM crew experience


    Give details of crew experience in RVSM operations (Please provide relevant experience
    of proposed crew) :

    OPS Procedures Form 1123 issue 08/03/2017 page 2/3


    Federal Public Service Mobility and Transport
    Belgian Civil Aviation Authority
    Operations Directorate

    V. RVSM equipment details


    Give details of RVSM equipment on board of the aircraft :

    Date of signature : (dd/mm/yyyy) Name & Signature of responsible manager :

    Number of attached annexes :


    1 RVSM airworthiness approval may need modification to the aircraft. Final approval may be subject to in-flight monitoring.
    2 Following documents shall be annexed :
    (1) Certificate of Registration (only for non-Belgian aircraft);
    (2) Certificate of Airworthiness (only for non-Belgian aircraft);
    (3) Airworthiness Review Certificate (only for non-Belgian aircraft);
    (4) Noise Certificate (only for non-Belgian aircraft);
    (5) Aircraft Radio Station License (only for non-Belgian aircraft);
    (6) Electronic Equipment List;
    (7) Amendments to the Operations Manual (including MEL, where applicable) or procedures manual (for NCO);
    (8) Training syllabi for initial and recurrent training programmes together with other relevant material;
    (9) Aircraft Flight Manual (AFM) amendment or supplement in relation to RVSM;
    (10) Copy of the manufacturer's statement, service letters STC, etc... in relation to RVSM;
    (11) Copy of the operator's engineering support attesting of the actions taken to implement the manufacturer's service
    bulletin, etc... (only in case there is no RVSM statement of the manufacturer).

    For MNPS Airspace, a separate MNPS approval is needed.

    OPS Procedures Form 1123 issue 08/03/2017 page 3/3

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