APPLICATION FOR INITIAL / AMENDMENT / RENEWAL / DUPLICATE OF PART-66 AIRCRAFT
MAINTENANCE LICENCE (AML) / EASA FORM 19
(Page 1)
APPLICANTS DETAILS:
Forename:Surname:
Permanent Address:
City: Postcode: Country:
Postal address :
Tel:Email:
Nationality: date of birth (dd/mm/yyyy): Place of birth:
Part 66 AML DETAILS (if applicable):
Licence FR.66.issue on :
EMPLOYER’S DETAILS:
Name of the current employer:
Address:
Maintenance Organisation Approval Reference:
Contact number:Contact email :
APPLICATION: (tick if appropriate)
InitialAmendmentRenewal Duplicate
CategoryAB1B2B3C
Aeroplane Turbine
Aeroplane Piston
Helicopter Turbine
Helicopter Piston
Avionics
Piston engine non-pressurisedaeroplanes of MTOM ≤ 2000 kg
Complex motor-powered aircraft
Aircraft other than complex motor-powered
Typequalifications:
limitationremoval:
DECLARATION OF APPLICANT (tick if appropriate)
I wish to apply for initial  / amendment/ renewal / duplicateof Part 66 AML as indicated and confirm that the information contained in this form was correct at the time of application.
I hereby confirm that :
1-I am not holding any art 66 AML issued in another Member State
2-I have not applied for any Part 66 AML in another Member State and
3-I never had a Part 66 AML issued in another Member State, which was revoked or suspended in any other Member State
Forename – Surname:
Signature : Date:
APPLICATION FOR INITIAL / AMENDMENT / RENEWAL / DUPLICATE / OF PART-66 AIRCRAFT
MAINTENANCE LICENCE (AML) / EASA FORM 19
(Page 2)
SUMMARY OF EXPERIENCE (not applicable for renewal/duplicate)
ATTESTATION OF EXPERIENCE
Forename Surname :Position :
Date :signature and stamp :
EXAMINATION/TRAINING COMPLETED
I wish to claim the following credits (if applicable):
Experience credit due Part 147 training
Examination credit due to equivalent exam certificates
RECOMMANDATIONOF MAINTENANCE ORGANISATION(only in case of specific authorization):
It is hereby certified that the applicant has met the relevant maintenance knowledge and experience requirements of Part 66 and it is recommended that the competent authority grants or endorses the Part “66 AML”.
Signature:Name:
Position:Date:
Organisation approvalnumber:

Information listed on the licenses is contained in a data file. In accordance with the provisions of articles 34 to 38 of the modified law n° 78-17 of January 6th, 1978, license holders have the benefit to access and correct the personal information with regard to them.

This right can be exerted by mail with an attached copy of the applicant’s ID addressed to:

OSAC – Pôle Formation

Immeuble Zénéo - Bât. B

14 Boulevard des Frères Voisin

92137 Issy-les-Moulineaux CEDEX.

FRANCE

EASA Form 19 – Issue 4