Užklausa

PRIOR PERMISSION REQUEST FORM

1. APPLICANT

1.1 Applicant Name and Surname *

1.2 Applicant Company *

1.3 Applicant e-mail *

1.4 Ground Handling Service Provider *

Litcargus Phone No. +370 618 83256; e-mail: [email protected]

Airo GH Phone No. +370 605 39 928; e-mail: [email protected]

2. AIR CARRIER OR AIRCRAFT OPERATOR

2.1 Air Carrier or Aircraft operator *

2.2. Air Operator Certificate No. *

2.3 Air Operator Certificate (AOC) *

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2.4 Air Operator Phone No. *

2.5. Air Operator E-mail *

2.6 Flight Owned or Chartered by *

3. FLIGHT INFORMATION

3.1 Aircraft Reg. No. *

3.2 Aircraft ID (Call Sign) *

3.3 Date of Flight (DOF) *

3.4 Aircraft Type *

3.5 Maximum Take-off Weight (MTOW) *

3.6 Type of Flight *

3.7 LTSA Form D No. *

4. ARRIVAL

4.1 Date of Arrival *

4.2 Aerodrome of Departure (ICAO) *

4.3 Aerodrome of Arrival (ICAO) *

4.4 Time of Arrival (UTC) *

4.5 Number of Crew and Passengers *

4.6 General Declaration for Crew and Passengers *

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4.7 Aerodrome Category for Rescue and Firefighting (RFF CAT) *

5. DEPARTURE

5.1 Date of Departure *

5.2 Time of Departure (UTC) *

5.3 Aerodrome of Destination *

5.4 Aerodrome Category for Rescue and Firefighting (RFF CAT) *

Confirmation of Provided Information *

By ticking this box, I confirm, that the provision of ground services is coordinated with the Ground handling service provider, specified in section 1.4.

By ticking this box, I confirm, that Aircraft, Aircraft operator (Legal and/or Natural person), Charterer (Legal and/or Natural person) of the flight and/or Ultimate beneficiary of the flight fully comply with sanctions imposed by EU Regulations or other states vis-a-vis Russian Federation (the RF) and its nationals & entities following its military aggression in and against Ukraine and accept full liability for the infringements and/or circumvention of the sanctions.

By ticking this box, I confirm, that provided information is correct and complete.

6. APPROVAL CODE

6.1 Approval Code *

PPR KUN/EYKA