<p> Federal Public Service Mobility and Transport Belgian Civil Aviation Authority Company Approvals Directorate –Operations Department</p><p>APPLICATION FORM AIR OPERATOR CERTIFICATE (AOC) This application form must be in possession of the Belgian CAA at least 90 days before the intended date of beginning of the planned operations (30 days in case of variation of an existing AOC) A1 Operator official name ______Address (registered office) ______Post code and Town ______Telephone number ______Telefax number ______</p><p>A2 Description of type of operations : Annex number :</p><p>Aeroplane operational base : Aeroplane type(s) and number MNPS ETOPS CAT II/III RNAV RVSM 1 Dangerous goods :</p><p>A3 Organisation of Management and organisation chart 2</p><p>A4 Name of Accountable Manager 3 :</p><p>A5 Flight Operations Manager 3 ______Training Manager 3 ______Ground Operations Manager 3 ______Continuing Airworthiness Manager 3______Quality Manager 3 ______</p><p>OPS Procedures Form 1119 issued 10/11/2006 Page 1/3 Federal Public Service Mobility and Transport Belgian Civil Aviation Authority Company Approvals Directorate –Operations Department</p><p>A6 Operations Manual Parts A – B – C – D and compliance check list form 1127 2</p><p>A7 Cabin attendant manual (CAM) and compliance check list form 1129 2</p><p>A8 Quality manual and compliance check list form 1128 2</p><p>A9 Safety briefing card (s)</p><p>B1 Operator’s Continuing Airworthiness Management Exposition (CAME) 2</p><p>B2 Operator’s aeroplane maintenance programme 2</p><p>B3 Technical log system, one copy of each form 2</p><p>B4 Technical specifications of all the maintenance contracts (signed) between the operator and the appropriate JAR-145 maintenance organisations 2</p><p>B5 Oversight of aeroplanes data, copy of the certificate of airworthiness (conform with ICAO Annex 8) for aeroplanes not registered in Belgium and registration letters to be mentioned in the AOC 2.</p><p>The applicant hereby certifies to be/not to be (delete accordingly) in possession of an AOC </p><p>OPS Procedures Form 1119 issued 10/11/2006 Page 2/3 Federal Public Service Mobility and Transport Belgian Civil Aviation Authority Company Approvals Directorate –Operations Department delivered by another Authority.</p><p>Date of signature : Signature of Accountable Manager</p><p>Number of attached annexes :</p><p>1 = if applicable, adequate application form must be annexed 2 = For an initial application for an AOC the documents, expositions and manuals to be annexed must be conform to IL/OPS, all CIR/OPS, all CIR/AIRW, all CIR/LIC, all CIR/TRNG, all CIR/EQUIP. 3 = Curriculum vitae form (BCAA Procedures form 1118) completed to be annexed Note : in case of variation of an AOC, only the relevant parts have to be filled in.</p><p>OPS Procedures Form 1119 issued 10/11/2006 Page 3/3</p>