Appendix V to ANNEX VI (Part-ARA) – Certificate for Aeromedical Centres (AeMCs)

CERTIFICATE FOR AERO-MEDICAL CENTRES (AeMCs)

European Union () Competent Authority

AERO-MEDICAL CENTRE CERTIFICATE

REFERENCE:

Pursuant to Commission Regulation (EU) No 1178/2011 and Regulation (EU) 2015/340 () and subject to the conditions specified below, the [competent authority] hereby certifies

[NAME OF THE ORGANISATION]

[ADDRESS OF THE ORGANISATION]

as a Part-ORA certified Aero-medical centre with the privileges and the scope of activities as listed in the attached terms of approval.

CONDITIONS:

1.This certificate is limited to that specified in the scope of approval section of the approved organisation manual;

2.This certificate requires compliance with the procedures specified in the organisation documentation as required by Part- ORA.

3.This certificate shall remain valid subject to compliance with the requirements of Part-ORA unless it has been surrendered, superseded, suspended or revoked.

Date of issue: dd/mm/yyyy: ………………………………………………………………….

Signature: [Competent Authority]: ……………………………………………………………

EASA Form 146 Issue 2

AERO-MEDICAL CENTRE CERTIFICATE Attachment () to AeMC certificate number:

PRIVILEGES AND SCOPE [Name of the organisation] has obtained the privilege(s) to undertake aero-medical examinations and assessments for the issuance of medical certificates and medical reports as stated in the table below and to issue these medical certificates and medical reports for:

Date of issue: dd/mm/yyyy: ………………………………………………………………….

Signature: [Competent Authority]: ……………………………………………………………