Äîäàòîê 2

                                         äî ïóíêòó 3.2 Ïðàâèë âèäà÷³ äîçâîë³â íà áîðòîâ³

                                          ðàä³îñòàíö³¿ öèâ³ëüíèõ ïîâ³òðÿíèõ ñóäåí Óêðà¿íè

   Äàòà   

 ................ð.

  Ðåºñòð. ¹

  ..................

  ÐÑ            

...................

    Äåðæàâíà ñëóæáà Óêðà¿íè ç íàãëÿäó çà çàáåçïå÷åííÿ áåçïåêè àâ³àö³¿

        ÐÏ

      UR-

       UR

    -----------------------------------------------

  ..................

 ....................

  ...................

            Óêðà¿íà, 01135, Êè¿â-135

  Äàòà âèäà÷³.......................

                 

         

             ïðîñïåêò  Ïåðåìîãè, 14.

ÇÀßÂÊÀ ÍÀ  ÂÈÄÀ×Ó  ÄÎÇÂÎËÓ

ÍÀ     ÁÎÐÒβ      ÐÀIJÎÑÒÀÍÖ²¯

öèâ³ëüíîãî ïîâ³òðÿíîãÎ ñóäíà

APPLICATION FOR AIRCRAFT RADIO STATION LICENSE CIVIL AIRCRAFT

1.

Äåðæàâíèé òà ðåºñòðà-

ö³éíèé  çíàêè ÏÑ

Aircraft national and

registration marks

 

2.

Ïîçíà÷åííÿ ÏÑ

âèãîòîâëþâà÷åì

Aircraft model

 

3.

Ñåð³éíèé íîìåð ÏÑ

Aircraft serial number

 

4.

Âëàñíèê ÏÑ òà éîãî

þðèäè÷íà àäðåñà

Aircraft’s Owner &

Owner’s address

 

5.

Åêñïëóàòàíò ÏÑ òà éîãî þðèäè÷íà àäðåñà

Aircraft’s Operator &

Operator’s address

 

                                                                    

                                                                                               Ïðîäîâæåííÿ äîäàòêà 2

6.

Ðàä³îîáëàäíàííÿ

Appareil

Òèï

Type

ʳëü

ê³ñòü

Quantity

Ïîòóæí³ñòü

(Âàò)

Puiss Watts

ijàïàçîí

Frequences Assignees

ѳòêà

õâèëü

Frequency

Step

 

Ðàä³îñòàíö³¿

Communication

Óêâ

VHF

         

êâ

HF

         

 

Íàâ³ãàö³éíå

Navigation

VHF

 

Êóðñ ÌÏ - 2

       

Êóðñ

Course

 

       

Ãë³ñàäà

Glide Slope

 

       

Ìàðêåð

Marker

 

       

Íàâ³ãàö³éíå   VLF   

            Navigation

 

       

Ðàä³îëîêàö³éíà ñòàíö³ÿ

Weather - Radar

         

Ðàä³îëîêàö³éíèé

â³äïîâ³äà÷

Transponder

“À/Ñ”

         

“S”

         

Ðàä³îäàëåêîì³ð “DME”

DME-Interrogator

         

Ðàä³îâèñîòîì³ð

Radio-Altimeter

         

Ðàä³îêîìïàñ

Radio-Compass

         

Àâàð³éíå îáëàäíàííÿ

Emergency- Equipment

         

Äîïëåð³âñüêèé âèì³ðþâà÷ øâèäêîñò³ òà çíîñó

Doppler Speed and drift Meter

         

Áîðòîâà ñèñòåìà ïîïåðåä æåííÿ ç³òêíåííÿ ó ïîâ³òð³

Traffic Alert Collision Sístem
         

  ,     ,      ,     ,      ,      ,      ,

         

ß öèì äîêóìåíòîì çàñâ³ä÷óþ, ùî âêàçàíà âèùå ³íôîðìàö³ÿ º òî÷íîþ ï³ä óñ³ìà  îãëÿäàìè. Ç Ïðàâèëàìè âèäà÷³ äîçâîë³â íà áîðòîâ³ ðàä³îñòàíö³¿ öèâ³ëüíèõ ïîâ³òðÿíèõ ñóäåí Óêðà¿íè îçíàéîìëåíèé.

I hereby declare that the above - mentioned particulars are true in all respects.

 

    Ïðîøó  âèïèñàòè îïëàòó çà âèêîíàíó ä³þ.

         ϳäïèñ çàÿâíèêà                          __________________      Ïð³çâèùå            

        Signature of Applicant                                                 Surname   _____________________

           Ïîñàäà            _____________________________________                 Äàòà                                              

           Title        Ì.Ï.                                                                                               Date   _____________________

    Îñîáà, ÿêà ïðèéíÿëà çàÿâêó ___________________________________

                                           (ïð³çâèùå òà ³í³ö³àëè)

        Äàòà  _________________    ϳäïèñ  _____________________