# Commission Regulation (EU) No 965/2012 of 5 October 2012 laying down technical requirements and administrative procedures related to air operations pursuant to Regulation (EC) No 216/2008 of the European Parliament and of the Council, Appendix IV

Extent: E+W+S+N.I.

Name and contact details of the CAA
Insertion of associated authorisation number.
Insertion of the operator's registered name and the operator's trading name, if different. Insert ‘ Dba ’ before the trading name (for ‘ Doing business as ’ ).
Operator's principal place of business address.
Operator's principal place of business telephone and fax details, including the country code. Email to be provided if available.
Insertion of the Commercial Aviation Safety Team (CAST)/ICAO designation of the aircraft make, model and series, or master series, if a series has been designated (e.g. Boeing-737-3K2 or Boeing-777-232). The CAST/ICAO taxonomy is available at: http://www.intlaviationstandards.org. The registration marks shall be either listed in the list of specific approvals or in the operations manual. In the latter case the list of specific approvals shall refer to the related page in the operation manual.
Specify the type of operation, e.g., agriculture, construction, photography, surveying, observation and patrol, aerial advertisement, maintenance check flights.
Listing of geographical area(s) or site(s) of authorised operation (by geographical coordinates or flight information region or national or regional boundaries).
Listing of applicable special limitations (e.g. VFR only, Day only, etc.).
Issue date of the authorisation (dd-mm-yyyy).
Title, name and signature of the CAA representative. In addition, an official stamp may be applied on the authorisation.
AUTHORISATION OF HIGH RISK COMMERCIAL SPECIALISED OPERATIONS
Civil Aviation Authority:
Authorisation no:
Operator name:
Operator address:
Telephone:
Fax
Email:
Aircraft model and registration marks:
Authorised specialised operation:
Authorised area or site of operation:
Special limitations:
This is to confirm that … is authorised to perform high risk commercial specialised operation(s) in accordance with this authorisation, operator's Standard Operating Procedures, Annex V to Regulation (EU) 2018/1139 and its delegated and implementing acts.
Date of issue :
Name and Signature :
Title:
CAA Form 151 Issue 1

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Source: https://www.legislation.gov.uk/eur/2012/965/annex/II/appendix/IV (the official version)
Page: https://openlegislation.uk/eu-regulation-2012-965/annex-II/appendix-IV
Contains public sector information licensed under the Open Government Licence v3.0. Source: legislation.gov.uk, The National Archives.