513B ATO Form v2017.2
513B ATO Form v2017.2
513B ATO Form v2017.2
A. ATO INFORMATION:
1. NAME OF ATO APPLICANT OR HOLDER 2. PERMANENT ADDRESS (Street or PO Box Number)
1. Issuance of a ATO Certificate and associated ratings to conduct the training courses identified below, and for the approval of these courses (three
copies of each course curriculums are attached).
ATO Certificate #: Expiration Date:
2. Renewal of existing ATO Certificate and associated ratings.
(a) Without changes to the currently approved course outline.
(b) With addition of course(s) identified below for which is requested (three copies of each course curriculums are attached).
(c) With deletion of course(s) identified below form the curriculum.
Propose Data:
1. ATO Training & Procedures Manual 5. Proposed Graduation Certificate 7. Quality Assurance System
2. Part 3 Conformance Checklist 6. Proposed Transcript Record 8. Instructor Resumes and their courses
3. Facility Description & Layout 7. Management Resumes 9. Safety Management System
4. Proposed Student & Staff Records 8. Instructor Resumes and their courses 10. Others:
If more space is needed, please attach additional page(s).
H. 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 to be considered as part of the basis for issuance of any CAAP certificate to me.
1. DATE 2. APPLICANT SIGNATURE:
A person shall not with intent to deceive or make any false
representation for the purpose of procuring for himself or
any other person the grant, issue, renewal or violation of any
3. PRINTED NAME AND TITLE OF APPLICANT:
such license…
I. CAAP CERTIFICATION:
1. APPROVED with associated ratings bearing the number shown above. 2. DISAPPROVED
Effective Date: Expires On: