April 2015 Form 2 (Rear)

Current PASA No.: / Applicant Name:
Note: Any fees due for licences or ratings to be paid to PASA - see account details below.
Section 1: New Licence Application. R100/licence application. CI to refer to PASA MOPs for details of requirements.
A Licence: / CI Initials: / B Licence: / CI Initials:
Total jumps (min.25): / A licence No.:
PASA Progression Programme: / Total FF Jumps (min 75):
Intermediate Skills Programme: / Cat III status (state discipline):
A licence PASA MOPs test: / % / B Licence PASA MOPs test: / %
Main parachute packing instruction: / Safe Canopy Control, Advanced Briefing:
C Licence: / CI Initials: / D Licence: / CI Initials:
B Licence No.: / C Licence No.:
Total FF jumps (min. 200): / Total FF jumps (min. 500):
Intentional night jump: / Nationals (Year & Discipline):
Water jump briefing: / J/M Rating No. JM
Spotting briefing and ability: / PASA Sanctioned Boogie:
C licence PASA MOPs test result: / % / Min. 2-way night jump (same discipline):
C licence minima in FS, CF, SAP, AE (tick) / D licence minima in FS, CF, SAP, AE (tick)
List of licence minima/jump numbers: (MUST be completed for C and D licence applications)
Note: For specific requirements list all jump numbers and date/s. CI to INSPECT logbooks and initial. Copies of relevant pages to accompany application for D licence. All requirements to be from one discipline.
Section 2: New Rating Application R100/rating application. NB: CI to check PASA MOPs for full details of requirements
Rating applied for: / Jumpmaster: / Coach (attach Form 19): / discipline: FS/ AE/ CF/ SAP/ CP/ WS
PRO (attach Form 3): / Rigging: RP / RS / RM: / Tandem#: V / SG / ST:
Instructor: / AFF Instructor: / Evaluator: SL / AFF / Tandem:
Venue and date/s of course:
Examiner/s:
Date apprenticeship completed: / CI Initials:
Note: # A R600 rating fee is payable per new Tandem Rating (in addition to the R100 admin fee) (V=Vector; SG=Sigma; ST=Strong)
Section 3: Rating Renewal/s. Note: CI to check logbooks for currency requirements as per PASA MOPs.
Renewal/s applied for: / *PRO: / Jumpmaster: / Coach: FSAECFSAPCPWS
*Rigging: / *Instructor: / *AFF Instructor:
*Tandem: / V / SG / ST / Evaluator: SL / AFF / Tandem
Note: * R100 rating renewal fee payable only in respect of PRO, Rigging, Tandem, Instructor and AFF Instructor ratings.
ADMIN Fees via Internet transfer or direct deposit (attach proof of payment):
Section 1. R100/New Licence: / R / * No fee for the renewal of existing licences, jumpmaster or coach ratings. / Bank: / Nedbank
Section 2. R100/New Rating: / R / Branch: / BOXER KAMAQHEKEZA
Section 2. R600/New Tandem Rating: / R / Code: / 198765 OR 151842
Section 3: R100/Selected Rating Renewals* / R / Account: / 1518 0192 69
Total fee: / R / Name: / PASA-ADZO
CI Name & Rating No (printed) / Insert initials and surname and/or PASA number as reference.
Please try to avoid cash deposits.
CI’s Signature: / Applicant’s Signature:
Note to CI: By signing here you verify that the applicant has:
1.  Met all the requirements for the licence/s and/or rating/s applied for; and/or
2.  Met all the renewal requirements for the above ratings. You MUST inspect the applicant’s logbooks!
For rigging: Master or Senior Parachute Technician or Evaluator to sign logbook.