AME WORK RECORD DGCA FORM 19-10

FORMAT OF AIRCRAFT MAINTENACE ENGINEER WORK RECORD / LOG BOOK DGCA INDIA CA Form 19-10

1. PERSONAL DETAILS Affix recent passport size photo graph duly attested on the front side

CEO Computer No E -

Name in Full

Date of birth * Nationality INDIAN

*Educational Qualification

GENDER M / F AMEL No.

*Permanent Address…………………………………………….................................…………………………………………………………………… PIN Code................................

Changed Permanent Address

*Address for Communication (if different from

above……………………….....................................................………………………………………………………………………………………………………….………………. PIN Code................................

Changed Address for Communication: Applicant Contact Phone Number ………………………….................. E-mail…….………………………………………………….

Name of the Current Employer : Contact Phone Number of Employer :

Log Book Owners Name……………………………………………………………………….. Signature ………………………………..

2. Record of Training: Training Completed

Training Establishment and Location

From To Result

3. (i) Details of Employer / Organisation at which engaged in Aircraft Maintenance Employer / Organisation: From To Position Nature of Work

Types of Aircraft or other products.

Conformation of organisation

Name Signature Position & Stamp date

Mr. S P Singh

Quality Manager/ Chief Engineer

3. (ii) Details of Employer / Organisation at which engaged in Aircraft Maintenance

Employer / Organisation:

From To Position Nature of Work

Types of Aircraft or other products Conformation of organisation

Name Signature Position & Stamp date

3. (iiI) Details of Employer / Organisation at which engaged in Aircraft Maintenance

Employer / Organisation: Conformation of organisation

From To Position Nature of Work

Types of Aircraft or other products

Name Signature Position & Stamp date

4. BASIC SKILL

Maintenance Task (1) Category Aircraft Reg No & Type (2)

Date on which performed (3)

Organisation (4) Supervisor name & AME no

All the applicable aircraft maintenance tasks listed under Addendum II to AMC of CAR‐66 should be reproduced under column (1). • Details of tasks performed should be furnished under column 2, 3, 4 and 5 • Maintenance tasks not performed should be indicated as “ NOT PERFORMED”

Declaration I hereby confirm that the information contained in this form was correct at the time of application PLACE SIGNATURE

DATE NAME

It is an offence to make, with intent to deceive, any false representations for the purpose of procuring the grant, issue, renewal or variation of any certificate, licence, approval, permission or other document. Personsdoing so render themselves liable to administrative/legal actions as per Aircraft Rules 1937. Further the licenceis liable for revocation / cancellation / suspension or permanently makes the person ineligible to have an AircraftMaintenance Engineer’s Licence