MEDICAL NOC APPLICATION

Medical Cell, DGCA

(Opp Safdarjung Airport), Aurobindo Marg
New Delhi – 110 003 Date: 03/08/2019

ISSUE OF NOC FOR CONDUCT OF CLASS-I MEDICALS

1. I,_________________(Name), PMR No 1- / -L-2 request for an NOC since (state reason(s) why NOC is required)

2. My details are as follows

(a) Email id______________________________________________________________________________
(b) Contact Number_______________________________________________________________________
(c) Postal Address________________________________________________________________________
(d) Age_________________________________________________________________________________
(e) Details of last medical
Date_____________________________________________________________________________
Place of Medical___________________________________________________________________
Type of Medical Class-1/ Class-2______________________________________________________
Status Fit/ Temporary Unfit/ Permanent Unfit_____________________________________________
(f) Forthcoming Medical
Date__________
Place_________
3. I have not exercised the privileges of my license when my medical was not valid.
4. NOC may be (select 1 option) posted to me/ sent along with PMR/ held at DGCA for collection by me.

Yours faithfully,

<SIGNATURE>

(<NAME>)

Enclosures:
1) Copy of Last Medical Assessment issued by DGCA (If not received, then CA-35 issued by Boarding Centre)
2) Copy of License
st
3) Copy of 1 & last page of logbook
4) Documents supporting reason for delay e.g. medical certificates if reason was medical.

REMARKS BY JDMS (CA):