NOTE: Applicants Are Strongly Advised to Read the PBN Notes for Approval from Procedure

Civil Aviation Authority of the Republic of Moldova Procedure Manual – Performance-Based Navigation Operational Approval Annex 6 – RNP 1 Approval Process Form When the approval process form has been accepted by CAA RM, It becomes the official schedule which will be used during the approval process

NOTE: Applicants are strongly advised to read the “PBN Notes for Approval” from “Procedure Manual – PBN Operational Approval”, Part 3 and “Applicant Advisory Pamphlet for PBN Approval”, before completing the form. Please complete the form in BLOCK CAPITALS using black or dark blue ink. Please note that a minimum of 30 working days will normally be required to check the information given below from the accepted date of application (Section 2, point e) – if data is missing or omitted the process may take considerably longer. General Information (Section to be completed by the applicant) Operator Name   Application for RNP 1 Operations Approval  Intended Date of Operations Initial AOC PBN Initial PBN Additional Certifi AOC Variation    Request  Request cation  Operator Name Phone No. E-mail Contact Details

Fleet Details (Section to be completed by the applicant) No. Aircraft type Aircraft series Serial number List Relevant Make and Model of Related Navigation Equipment

Date Remarks 1 Phase one: Pre-application (columns to be completed by the applicant)

Applicant making an initial inquiry by letter, phone or fax to CAA RM, and a appoints a pre-application meeting

b Initial Contact (pre-application meeting) CAA Certification Commission provide the applicant with: PM-PBN-AN-06 Rev No: 00 / 31.10.2014 Page 1 of 24 (1) Information regarding applicable regulations and means of compliance Guidance related to the application, application attachments and the approval (2) process i For AOC initial certification. It will be part of certification process meetings ii For AOC variation. a meeting with the applicant representative will be set (3) The Approval Process Form and the items which are necessary to be completed

Date Inspectors notes 2 Phase two: Formal application YES NO

a Applicant making a formal application to CAA RM □ □

b AOC Initial certification/variation/renewal application form □ □

c PBN Approval Process Form □ □

d PBN Application Attachments □ □

Indic Inspectors notes a YES NO ti o n o f i n cl u si o n b y t h e o p e r a t Civil Aviation Authority of the Republic of Moldova Procedure Manual – Performance-Based Navigation Operational Approval Annex 6 – RNP 1 Approval Process Form When the approval process form has been accepted by CAA RM, It becomes the official schedule which will be used during the approval process

o r (colu m n t o b e c o m p l e t e d b y a p p li c a n t) Aircraft eligibility — airworthiness. AFM, AFM revision, AFM supplement, TCDS (1) showing that the aircraft RNP 1 systems are eligible. □ □ Aircraft eligibility — modifications (if applicable). Maintenance records documenting (2) installation or modification of aircraft systems to achieve eligibility. □ □ Maintenance program. Continuing airworthiness instructions applicable to the aircraft‘s (3) qualification for RNP1 specifications. Navigation database maintenance practices. □ □

PM-PBN-AN-06 Rev No: 00 / 31.10.2014 Page 3 of 24 Minimum equipment list (MEL) if applicable. Any revisions of MEL to address RNP1 (4) must be approved □ □ (5) Navigation database. Details of the validation program and procedures. □ □ Training. Training program for flight crews, flight dispatchers, and maintenance personnel (6) as applicable. □ □ Operating policies and procedures including relevant section of Operations Manuals and (7) checklists attached to the application, applicable to RNP 1 . □ □ Civil Aviation Authority of the Republic of Moldova Procedure Manual – Performance-Based Navigation Operational Approval Annex 6 – RNP 1 Approval Process Form When the approval process form has been accepted by CAA RM, It becomes the official schedule which will be used during the approval process

Head of Flight Operation Division & Head of Airworthiness Division e appoints approval team which consists of: (to be completed only by CAA) PBN approval team members (1) name: Flight Operation Inspector – Project (a) manager Flight Operations Inspector – PBN specialist (b) (if necessary) (c) Airworthiness inspector Approval team review of the (2) applicant PBN approval application form Approval team appoints a date for formal application (3) meeting and inform the applicant and Certification Commission

Formal application meeting (to be f completed only by CAA) Objective. the reception of PBN approval application attachments, review the approval process and (1) establish a common understanding on the future procedure for the approval process (2) Attendees: (a) Certification team PM-PBN-AN-06 Rev No: 00 / 31.10.2014 Page 5 of 24 Applicant post holders (Flight operations, Crew training & (b) Maintenance system) or their permanent approval representative The formal application, application (3) attachments and approval process form are: (a)  Accepted  Rejected Date (b) Team Leader name: Signature : Civil Aviation Authority of the Republic of Moldova Procedure Manual – Performance-Based Navigation Operational Approval Annex 6 – RNP 1 Approval Process Form When the approval process form has been accepted by CAA RM, It becomes the official schedule which will be used during the approval process

Operator Documents AW Inspector notes ICAO Doc 9613 Reference (column to be completed by 3 Phase three: Documents Evaluation Vol. II Part C 3 (column to be completed by the AW inspector) the applicant) Comp Non- 3a Airworthiness Division Documents Evaluation com Remarks pl.

Airworthiness documents showing aircraft eligibility for RNP1. Eligibility Provision of aircraft’s □ a documents (Type Certificate, AFM 3.3.2.2 □ N □ R #_____ supplements) to comply with NAA C (e.g.: EASA or FAA) RNP1 specifications

Aircraft Equipment. The Operator must provide configuration list and MEL □ b 3.3.2.3.1 detailing the required aircraft □ N □ R #_____ equipment for RNP1 operations. C □ c On-Board Monitoring System 3.3.3.2-5 □ N □ R #_____ C □ (1) Accuracy: 3.3.3.2.1 □ N □ R #_____ C (2) Integrity: OM reference and procedure. 3.3.3.2.2 □ □ □ R #_____ N

PM-PBN-AN-06 Rev No: 00 / 31.10.2014 Page 7 of 24 C

Continuity: OM reference and □ (3) 3.3.3.2.3 procedures □ N □ R #_____ C On-Board performance Monitoring □ (4) and Alerting: Checklist and SOP 3.3.3.2.4 □ N □ R #_____ procedures C □ (5) S/S: Checklist and SOP procedures 3.3.3.2.5 □ N □ R #_____ C □ d Functional requirements 3.3.3.4 □ N □ R #_____ C

Maintenance program. : The operator must submit CAMO instructions to the aircraft configuration and □ e 3.3.2.3.5 qualification for RNP1 specification □ N □ R #_____ and must include reliability program C for monitoring the equipment. Civil Aviation Authority of the Republic of Moldova Procedure Manual – Performance-Based Navigation Operational Approval Annex 6 – RNP 1 Approval Process Form When the approval process form has been accepted by CAA RM, It becomes the official schedule which will be used during the approval process

d Airworthiness Inspector Remarks (section to be completed by AW Inspector)

PM-PBN-AN-06 Rev No: 00 / 31.10.2014 Page 9 of 24 R

(k) Civil Aviation Authority of the Republic of Moldova Procedure Manual – Performance-Based Navigation Operational Approval Annex 6 – RNP 1 Approval Process Form When the approval process form has been accepted by CAA RM, It becomes the official schedule which will be used during the approval process

e Airworthiness Division letter declaring that, the applicant meets or does not, airworthiness requirements for RNP 1 approval (section to be completed by AW Inspector) (b) AW Inspector name: Signature : Date: Civil Aviation Authority of the Republic of Moldova Procedure Manual – Performance-Based Navigation Operational Approval Annex 6 – RNP 1 Approval Process Form When the approval process form has been accepted by CAA RM, It becomes the official schedule which will be used during the approval process

Operator Documents OPS Inspector notes ICAO Doc 9613 Reference (column to be completed by 3 Phase three: Documents Evaluation (continue) Vol. II Part C 3 (column to be completed by the OPS inspector) the applicant) Comp Non- co Remarks 3b Flight Operation Division Documents Evaluation mpl

Minimum Equipment List (MEL). Must be adjusted to specify the required □ a dispatch conditions. All necessary 3.3.2.3.4 □ N □ R #_____ revisions to address RNP1 must be C approved □ b Navigation database 3.3.6 □ N □ R #_____ C □ (1) The Database. 3.3.6.1 □ N □ R #_____ C

SID & STAR NOTAM system □ (2) 3.3.6.2 requirements □ N □ R #_____ C

Operators database Quality system □ (3) 3.3.6.3 requirements. □ N □ R #_____ C

c Training program 3.3.2.3.2 □ □ □ R #_____ 3.3.5 N

PM-PBN-AN-06 Rev No: 00 / 31.10.2014 Page 13 of 24 C □ (1) Flight crews 3.3.5 □ N □ R #_____ C □ (2) Flight dispatchers AMC-FD 4.4.3 □ N □ R #_____ C □ (3) Maintenance personnel Refer to AW □ N □ R #_____ C

Procedures and Policies for RNP □ d 3.3.4 1Operations □ C □ R #_____

□ (1) Flight planning 3.3.4.2 □ N □ R #_____ C

Verify that the aircraft and crew are □ (a) 3.3.4.1 approved for RNP 1 operations. □ N □ R #_____ C

3.3.4.2.3 □ (b) Verify RAIM availability □ □ R #_____ 3.3.4.3 N C

Verify that the navigation database is □ (c) 3.3.4.2.2 current. □ N □ R #_____ C Verify the FPL: □ (d) “R” should appear in field 10 and 3.3.4.2.1 □ N □ R #_____ PBN/O2 in field 18. C Civil Aviation Authority of the Republic of Moldova Procedure Manual – Performance-Based Navigation Operational Approval Annex 6 – RNP 1 Approval Process Form When the approval process form has been accepted by CAA RM, It becomes the official schedule which will be used during the approval process

Operator Documents Inspector Remarks ICAO Doc 9613 Reference (column to be completed by 3 Phase three: Documents Evaluation (continue) Vol. II Part C 3 (column to be completed by the OPS inspector) the applicant) Comp Non- co Remarks 3b Flight Operation Division Documents Evaluation (continue) mpl

□ (2) General operating procedures 3.3.4.4 □ N □ R #_____ C

Comply with the manufacturer’s □ (a) 3.3.4.4.1 instructions/procedures. □ N □ R #_____ C

Advise ATC if unable to comply with the □ (b) 3.3.4.4.2 requirements for RNP 1. □ N □ R #_____ C

Verify aircraft position and entry of □ (c) 3.3.4.4.3 assigned route. □ N □ R #_____ C

Retrieve SIDs/STARs only from the □ (d) 3.3.4.4.4 database. □ N □ R #_____ C

Cross-check the chart with the RNAV □ (e) 3.3.4.4.5 system display. □ N □ R #_____ C (f) Cross-check with conventional 3.3.4.4.6 □ □ □ R #_____ NAVAIDS to monitor for PM-PBN-AN-06 Rev No: 00 / 31.10.2014 Page 15 of 24 N navigational reasonableness. C □ (g) Use an appropriate display. 3.3.4.4.7 □ N □ R #_____ C □ (h) Use appropriate scaling. 3.3.4.4.7 □ N □ R #_____ C □ (i) Follow route centre line within 0.5 NM. 3.3.4.4.8 □ N □ R #_____ C Do not modify the flight plan in the RNAV system after ATC heading □ (j) assignment until a clearance is 3.3.4.4.9 □ N □ R #_____ received to re-join the route or a C new clearance is confirmed.

If RNP input is required, select RNP 1 or □ (k) 3.3.4.5 lower. □ N □ R #_____ C □ (3) RNP 1 SID requirements 3.3.4.6 □ N □ R #_____ C Prior to take-off check the RNAV system, the aerodrome and □ (a) 3.3.4.6.1 procedure loaded and the displayed □ N □ R #_____ position. C

Engage LNAV no later than 500 ft above □ (b) 3.3.4.6.2 aerodrome elevation. □ N □ R #_____ C (c) Use an authorized method to achieve 3.3.4.6.3 □ □ □ R #_____ RNP 1 (AP/FD/Map/ L/DEV 3.3.4.6.5 N indicator). C (d) If GNSS, signal must be acquired before 3.3.4.6.4 □ □ □ R #_____ start of take off roll. N C Civil Aviation Authority of the Republic of Moldova Procedure Manual – Performance-Based Navigation Operational Approval Annex 6 – RNP 1 Approval Process Form When the approval process form has been accepted by CAA RM, It becomes the official schedule which will be used during the approval process

Operator Documents Inspector Remarks ICAO Doc 9613 Reference (column to be completed by 3 Phase three: Documents Evaluation (continue) Vol. II Part C 3 (column to be completed by the OPS inspector) the applicant) Comp Non- co Remarks 3b Flight Operation Division Documents Evaluation (continue) mpl

□ (4) RNP 1 STAR requirements 3.3.4.7 □ N □ R #_____ C

Verify that the correct STAR is loaded □ (a) 3.3.4.7.1 and displayed. □ N □ R #_____ C □ (b) Contingency preparations. 3.3.4.7.3 □ N □ R #_____ C

Procedure modifications in response to □ (c) 3.3.4.7.4 ATC instructions. □ N □ R #_____ C Verify the correct operation of the navigation system and that the □ (d) 3.3.4.7.5 correct procedure, transition and □ N □ R #_____ runway are loaded. C

Observance of speed and altitude □ (e) 3.3.4.7.6 constraints. □ N □ R #_____ C PM-PBN-AN-06 Rev No: 00 / 31.10.2014 Page 17 of 24 If the procedure is more than 30 NM □ (f) from ARP use FD/AP or set FSD to 3.3.4.7.7 □ N □ R #_____ 1 NM. C □ (5) Contingency procedures 3.3.4.8 □ N □ R #_____ C

Advise ATC if unable to comply with the □ (a) 3.3.4.8.1 requirements for RNP 1. □ N □ R #_____ C 3.3.4.8.2 (Doc 4444 □ (b) Air-ground communications failure. □ □ R #_____ Chapter 15, N C 15.3) Civil Aviation Authority of the Republic of Moldova Procedure Manual – Performance-Based Navigation Operational Approval Annex 6 – RNP 1 Approval Process Form When the approval process form has been accepted by CAA RM, It becomes the official schedule which will be used during the approval process

f Flight Operation Inspector Remarks (section to be completed by OPS Inspector)

(k) R Civil Aviation Authority of the Republic of Moldova Procedure Manual – Performance-Based Navigation Operational Approval Annex 6 – RNP 1 Approval Process Form When the approval process form has been accepted by CAA RM, It becomes the official schedule which will be used during the approval process

Flight Operation Division letter to the applicant, declaring that, the applicant meets or does not, airworthiness and operational requirements for RNP 1 approval (section to be g completed by OPS Inspector) (a) OPS Inspector name: Signature : Date: (b) Date of receiving corrective actions:

Proposed date (column to be Accomplished date Remarks 4 Phase four: Demonstration and inspection completed (column to be completed by (column to be completed by by the the OPS Inspector) the OPS Inspector) applicant)

a Flight Operation Division (1) Flight crew training program inspection (2) Flight crew qualification and training records inspection (3) Aircraft dispatcher training program inspection (4) Aircraft dispatcher qualification and training records inspection Civil Aviation Authority of the Republic of Moldova Procedure Manual – Performance-Based Navigation Operational Approval Annex 6 – RNP 1 Approval Process Form When the approval process form has been accepted by CAA RM, It becomes the official schedule which will be used during the approval process

(5) Release of Flight/Dispatch Inspection

b Airworthiness Division (1) Refer to Airworthiness team member

c Operator’s Declaration (Section to be completed by the applicant) The undersigned certify that statements and answers provided in this approval process form and attachments are complete and true to the best of my knowledge and agree that they are to be considered as part of the basis for issuance of PBN approval in accordance with JAR OPS 1 and ICAO Doc. 9613 Title Name Surname Signature Date Flight Operations Post Holder Crew Training Post Holder Maintenance System Post Holder Accountable Manager

PM-PBN-AN-06 Rev No: 00 / 31.10.2014 Page 23 of 24 Flight Operation Division letter to the applicant, declaring that, the applicant meets and complies or does not, airworthiness and operational requirements for RNP 1 approval d (section to be completed by OPS Inspector) (a) OPS Inspector name: Signature : Date: Date of receiving corrective actions plan (b) :

FOR CAA RM USE ONLY

5 Phase five: CAA RM Approval

a PBN Approval Report Contents (1) AOC Variation application form □ (2) PBN approval process form □ Airworthiness Division letter declaring that, the applicant meets airworthiness requirements for RNP 1 (3) approval □ Flight Operation Division letter declaring that, the applicant meets and complies with operational and (4) airworthiness requirements for RNP 1 approval □ (5) Official report regarding AOC modification □

b Director CAA RM signing Date (1) Amendment of the OPS SPECS for RNP 1 approval