REPÚBLICA PORTUGUESA MINISTÉRIO DA DEFESA NACIONAL AUTORIDADE AERONÁUTICA NACIONAL

DIPLOMATIC CLEARANCE NOTIFICATION OR REQUEST FORM 1 – Call Sign: 2 – Sending State: 3 – Number of Aircraft / Type / Registration: 4 – Blanket Diplomatic Clearance (DCN) if any:

6 –Aircraft Operator: 5 – Spare aircraft:

7 – Purpose of flight:

8 – Aircraft commander’s name and rank, as well as, number and nationality of the crew members:

9 – Number of passengers and nationality (name and title/functions of any VIP on board):

10 – Technical data: Last airfield Entry point in Portuguese Exit point of First airfield Airfield Date (ICAO) before Portuguese FIR’S airfield requested Portuguese FIR’S (ICAO) after Destination of of Portugal (report point or (if any) (report point or Portugal airfield origin flight and ETD LAT/LONG) and LAT/LONG) and ETA (ICAO) (ICAO) (HHMM) and ETO ETA / ETD and ETO (HHMM)

11 – Route to be flown in Portugal, including reporting points and airways or geographic coordinates (Latitude/Longitude):

12 – Alternate airfields in Portugal (if any):

13 – Other information: A. Will the aircraft transport Any Items included in United Nations List of Dangerous Goods inserted in the “Recommendations on the Transport of Dangerous Goods”, as well as, those included in the “Common Military List” of the European Union, in force in Portugal? YES NO  If YES – Please fill out the “ANNEX TO DIPLOMATIC CLEARANCE NOTIFICATION OR REQUEST FORM”. – Is all the cargo declared in Annex to your own use? YES NO  If NO, please send a request for a transit Permit to: Ministry of Defense Tel: +351 213 038 571 Av. Ilha da Madeira Fax: +351 213 027 221 1400‐201 Lisboa eMail: [email protected] Portugal B. Will the aircraft carry any photographic sensors or cameras, data collection equipment or electronic warfare equipment? YES NO

14 – Remarks (please use this field for any additional information):

(Signature of the Applicant) DATE: ______/______/______

ANNEX TO DIPLOMATIC CLEARANCE NOTIFICATION OR REQUEST FORM:

DANGEROUS GOODS DETAILS Please be aware that, despite only Class 1 items have to fill in the last Column, all items must be mentioned on this Annex. We recommend www.aan.pt/dip.clearances/hazardous goods/ for any questions about these items.

UN Number/ Net Explosive Class or Gross Total Net EU Common Proper Shipping Name Weight Division Weight Quantity Military List (Class 1)

Call Sign: Date of flight: