STATE OF LIBYA

CIVIL AVIATION AUTHORITY APPLICATION FORM FOR

FLIGHT SAFETY DEPARTMENT RENEWAL FLIGHT DISPATCHER
PEL SECTION LICENSE
Flight Dispatcher License Renewal Application Form
1.Personal details
Applicant’s name

Date of birth Place of birth

Nationality ID No./Passport No.
Address Phone No.
Email

2. licence Information
State of license issue License type & number
License Expiry Date Type Rating Indorsed

3. Medical Certificate Information

Date of issue Validity
Class Limitation

4. Flight Dispatcher License Renewal Requirements (please ) and must be attached 

A  Flight dispatcher employed by AOC holder.
(1) Valid 12 month recurrent training; and ,
(2) Refresher training course from approved training organization .
(3) Valid Medical Certificate.
(4) Valid ELP at least level four.
B  Flight dispatcher is not employed by AOC holder.
(1) Refresher training course from approved training organization.
(2) Valid Medical Certificate .
(3) Valid ELP at least level four .

5. SUPPORTING DOCUMENTS (please ) and must be attached 

a- Cover Letter from the AOC
b-This application form.
c- Copy of valid 12 month recurrent training certificate; and
d- Refresher training course from approved training organization
e- Valid Medical Certificate
f- FEES

6. Applicant Signature
I hereby declare that:
• The information given is true and correct and that the documents attached are authentic
Applicant Name :
Date : Applicant Signature :

FSD-PEL-19- F.DIS ISSUE DATE: 19-07-2018