Division ARA.MED.130 Medical certificate formatF1F2

The medical certificate shall conform to the following specifications:

1. (a)

   Content

   1. (1)

      State where the pilot licence has been issued or applied for (I),

   2. (2)

      Class of medical certificate (II),

   3. (3)

      Certificate number commencing with the UN country code of the State where the pilot licence has been issued or applied for and followed by a code of numbers and/or letters in Arabic numerals and latin script (III),

   4. (4)

      Name of holder (IV),

   5. (5)

      Nationality of holder (VI),

   6. (6)

      Date of birth of holder: (dd/mm/yyyy) (XIV),

   7. (7)

      Signature of holder (VII),

   8. (8)

      Limitation(s) (XIII),

   9. (9)

      Expiry date of the medical certificate (IX) for:

      1. (i)

         Class 1 single pilot commercial operations carrying passengers,

      2. (ii)

         Class 1 other commercial operations,

      3. (iii)

         Class 2,

      4. (iv)

         LAPL

   10. (10)

       Date of medical examination

   11. (11)

       Date of last electrocardiogram

   12. (12)

       Date of last audiogram

   13. (13)

       Date of issue and signature of the AME or medical assessor that issued the certificate. GMP may be added to this field if they have the competence to issue medical certificates under F3a relevant enactment.

   14. (14)

       Seal or stamp (XI)

2. (b)

   Material: Except for the case of LAPL issued by a GMP the paper or other material used shall prevent or readily show any alterations or erasures. Any entries or deletions to the form shall be clearly authorised by the F4CAA.

3. (c)

   Language: Certificates shall be written in the national language(s) and in English and such other languages as the F5CAA deems appropriate.

4. (d)

   All dates on the medical certificate shall be written in a dd/mm/yyyy format.