ENGINEERING PROCEDURE

SUBJECT : NO. :
DATE :
APLICATION FOR AIRWORTHINESS
REFERENCE : Advisory Circular
CERTIFICATE 21 – 12
PREPARED BY : DINA A’LA SHOFI ZAHROH CHECKED BY:

PROCEDURE
NO. : 30420038 DATE :
NO. DESCRIPTION Remark sign

IDENFITICATION
A. AIRCRAFT DESCRIPTION
1. Registration Mark
(Tanda Pendaftaran)
2. Aircraft Builder’s Name (Make).
(Nama Pembuat Pesawat).
3. Aircraft Model Designation
(Desain Model Pesawat)
4. Year of Manufacture
(Tahun Pembuatan)
5 Serial Number
(Nomer Seri)
6 Engine Builder’s Name (Make).
(Nama Pembuat Engine)
7 Engine Model Designation
(Penandaan Model Engine)
8 Number of Engines
(Nomer Engine)
9 Propeller Builder’s Name (Make).
(Nama Pembuat propeller)
10 Propeller Model Designation.
(Penandaan Model Propeller)
11 Aircraft is Import.
(Pesawat Import)
FORM NO PAGE 1 OF 3
 PROCEDURE
NO. : 30420038 DATE :

NO. DESCRIPTION Remark sign

IDENFITICATION
B. CERTIFICATION REQUESTED
1. Standard Airworthiness Certificate
(Sertifikat Standar Kelaikan Udara)
2. Special Airworthiness Certificate.
(Sertifikat Khusus Kelaikan Udara)
3. Multiple Airworthiness Certificate, i.e., Stan-
dard / Restricted or Restricted
/ Limited
(Sertifikat Kelaikan Udara Berganda, yaitu
Standar / Dibatasi atau Dibatasi/ Terbatas)

FORM NO PAGE 2 OF 3
 PROCEDURE
NO. : 30420038 DATE :
NO. DESCRIPTION Remark sign

IDENFITICATION
A. OWNER’S CERTIFICATION
1. Registered Owner
(Pemilik Terdaftar)
2. Aircraft Certification Basis (Aircraft Speci-
fication or Type Certificate Data
Sheet and/or Aircraft Listing Block).
(Dasar Sertifikasi Pesawat (Spesifikasi Pe-
sawat atau Data Jenis Sertifikat
Sheet dan/atau Blok Daftar Pesawat).
3. Airworthiness Directives.
(Petunjuk Kelaikan Udara)
4. Supplemental Type Certificate.
(Sertifikat Tipe Tambahan)
5 Aircraft Operation and Maintenance
Records.
(Catatan Pengoperasian dan Pemeli-
haraan Pesawat Udara)
6 Certification.
(Sertifikasi)
FORM NO PAGE 3 OF 3
 PROCEDURE
NO. : 30420038 DATE :
NO. DESCRIPTION Remark sign

ISSUANCE OF BASIC CERTIFICATE

A. REVIEW APPLICATION
1. Applicatioan Letter for Basic Certificate
signed by Head of Maintenace / Head of
Training
2. Transcript and Graduation Certificate for
AMTO student certificated under part 147
3. DGCA Form No. 65-06 Statement of Com-
petency for applicant who have not gradu-
ated from DGCA approved AMTO under
part 147
4. Current Certificate of English Proficiency
(at least 24 months ) able to read, write,
speak and understand the technical English
5 National ID for indonesia citizen
6 Pas Photo (4 x 6 , red background).
7 Writen test result provided by AMTO with
examaining authority
8 Writen test result provided by AMTO with
examaining authority
B. ONLINE PROCEDURE FOR EX-
AMINATION FOR BASIC LICENSE
1 Operator input data and upload application
document to pel.dephub.go.id application
2 Operator request payment billing number
to pay PNBP of Basic Certificate Examina-
tion on pel.dephub.go.id application
3 After operator has paid PNBP, application
document submitted will appear on Head
section of aircraft maintenance personel li-
censing portal and then forward to Inspec-
tor of Personel Licensing by disposition
4 Inspector will verify attached requirement,
if requirement has completed
5 Approved application will send to PEL-
Officer Account and PELOfficer will set
 examination schedule and location, also in-
put examination result for written examina-
tion.
6 Head Section of aircraft maintenance per-
sonel licensing verify Score has been input
by PEL Officer.
7 Operator will get notification examination
result, if passed, applicant may continue to
issuance Basic Certificate, and if failed, ap-
plicant must reapplication for Basic Certifi-
cate Examination
FORM NO PAGE 3 OF 3