Application for

. Special Flight Permit

CAR 5.4.1.11.4 FSIS Form SPF-001
03 OCT 2012

Republic of the Philippines

CIVIL AVIATION AUTHORITY OF THE PHILIPPINES

1. Aircraft Description and Location (Please print or type and check appropriate box)
Nationality and Registration Mark Aircraft Manufacturer
Aircraft Model Designation
RP- Aircraft Serial No.
Place and Year of Manufacture
Aircraft Location and Maintenance Organization (if applicable)

2. Purpose of the Flight (refer Subsection 5.4.1.11.4 of PCAR Part 5)

Ferry flight for repairs, alterations, maintenance or storage Delivering or exporting of aircraft.

Evacuation from area of impending danger Operation in excess of Maximum Certificated Take-Off Weight

Production flight testing Customer demonstration flights (new aircraft)

Note: See overleaf for other details required from applicant for the issuance of Special Flight Permit.

3. Proposed Itinerary

Flight Details

From ____________________________ To _____________________________ Via ________________________

(Place) (Place) (Place)
Period for which the Special Flight Permit is requested

From ________________________ To __________________________ Proposed Departure Date ______________________

(MM/DD/YY) (MM/DD/YY) (MM/DD/YY)

4. Applicant’s Information

Name of Applicant ______________________________________________________________________________________

(First Name) (Middle Name) (Last Name)
Business or Residential Address ___________________________________________________________________________
_________________________________________ Postal Code _______________
Office Tel. No. ________________________ Residential Tel. No. ______________________ Fax No. __________________

Signature ________________________________________________ Date ______________________

Owner / Operator Authorized Representative (MM/DD/YY)
(Please check the appropriate box)
5. CAAP Delegated Person
The undersigned affirms that subject aircraft in this authorization is safe to carry out aforementioned flight itinerary within the
specified period stated herein.

From _____________________________ To _____________________________ Via ________________________________

(Place) (Place) (Place)
for the purpose requested above. Terms and Conditions apply (see overleaf )

Special Flight Permit No. ____________________ Issued Date ____________________ Expiry Date ____________________
(MM/DD/YY) (MM/DD/YY)
CAAP delegated personnel’s signature:

Printed Name _______________________________________ Signature __________________ Date ____________________

(FN ) (MI) (LN) (MM/DD/YY)
6. Other details required from the Applicant for the issue of the Special Flight Permit

(a) Name/s of the crew essential in the operation of aircraft and its equipment (e.g. pilot, co-pilot, navigator, etc.)
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

(b) Reason/s for the non-compliance of applicable airworthiness standards. [e.g. major defects, damage, unapproved
modifications, outstanding Airworthiness Directives (ADs), etc.]
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

(c) Restrictions considered necessary by the applicant for the safe operation of aircraft. (see Subsection 5.4.1.11 of PCAR
Part 5)
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

(d) Other information (aircraft condition)

(i) Is the Maintenance Release expired? Yes No

If “Yes”, how long it has been expired? _______ Hours; when was the expiration date ______________ (MM/DD/YY)
(ii) For what reason did the Maintenance Release / RTS expire?
____________________________________________________________________________________________
(iii) When was the aircraft last flown? _________________________________ Date ___________________________
(iv) When was the engine last run? _________________________________ Date____________________________
(v) Has the engine(s) been maintained to manufacturer’s procedures for inactive engine protection?
Yes No, If “No”, supply details of alternative procedures.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Note: Use attachments if necessary for above items.

7. Terms and Conditions (for CAAP use only)

This Special Flight Permit is subject to terms and conditions listed hereunder as follows:

1. A copy of this permit must be carried onboard the aircraft whenever operating under the terms and conditions of this permit;
2. In compliance with PCAR Part 4, aircraft registration mark assigned by this Agency must be displayed accordingly;
3. No person or property shall be carried onboard the aircraft for compensation or hire;
4. The aircraft shall be operated only by crew who are aware of the purpose of the flight and any limitations imposed, and who
hold appropriate certificates or licenses issued or validated by the CAAP;
5. No person should be carried onboard the aircraft, unless that person is essential to the purpose of the flight and has been advised
of the contents of this authorization and the airworthiness status of the aircraft;
6. All flights must be conducted within the performance operating limitation prescribed in the aircraft flight manual and those
additional limitations specified by the CAAP and/or Type Design Approval Holder;
7. All flights must avoid airspace with heavy traffic or any other areas where flights might create exposure to persons or property.
8. Not valid for use in foreign airspace unless validated by the foreign CAA whose airspace will be flown over;
9. All flights should be conducted in accordance with the applicable general operating rule of the Philippines or the State where
the operations are conducted;
10. All flight should be conducted within the prescribed period of this authorization; and
11. (Other conditions)
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Note: Use attachments if necessary for above items.

_______________________________________________________ _______________________________
Airworthiness Inspector’s signature over printed name Date