Diplomatic Clearance Request

CZ Czech Republic Overflight and/or landing of foreign state aircraft

DIPLOMATIC CLEARANCE REQUEST

SECTION ARequest details 1. State of registry 2. Owner of aircraft 3. Type of aircraft (alternate acft. if any) and MTOW 4. Aircraft registration 5. Radio call sign(s) 6. Flight number (if applicable) 7. Military/police/customs/civil aircraft 8. Pilot-in-command (name) 9. Number of crew 10. Number of passengers 11. Position/rank of VIP passenger 12. Purpose of flight

SECTION BRoute/Flight itinerary in UTC 13. Departure aerodrome (ICAO) and ETD 14. Destination aerodrome (ICAO) and ETA Date and time of entry into the airspace of 15. the Czech Republic Date and time of exit from the airspace of 16. the Czech Republic Arrival aerodrome in the Czech Republic 17. Date and time of landing Departure aerodrome in the Czech Republic 18. Date and time of departure 19. Required services (e.g. fuel, accommodation)

SECTION CEquipment and cargo 20. Communication, navigation, transponder 21. Built-in armament and photographic equipment Dangerous/hazardous cargo UN classification 22. Indicate consignor/consignee if the cargo is destined for third subject (e.g. on behalf of MOD). If you need to provide more details, use the Annex.

SECTION DRemarks Blanket clearance number (annual, permanent) if 23. any

SECTION E Decision TO BE COMPLETED BY CZECH AUTHORITIES Clearance number Date, note (to be used in Box 18 of ICAO flight plan)

Validity of clearance: CZ Czech Republic Overflight and/or landing of foreign state aircraft