Appendix VII to ANNEX VI (Part-ARA) – Certificate for Aeromedical Examiners (AMEs)

CERTIFICATE FOR AERO-MEDICAL EXAMINERS (AMEs)

European Union () Competent Authority

AERO-MEDICAL EXAMINER CERTIFICATE

CERTIFICATE NUMBER/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 AERO-MEDICAL EXAMINER]

[PRACTICE ADDRESS(ES) OF THE AERO-MEDICAL EXAMINER]

as aero-medical examiner

CONDITIONS:

1.This certificate is limited to the privileges specified in the attachment to this AME certificate;

2.This certificate requires compliance with the implementing rules and procedures specified in Part-MED/Part ATCO.MED ().

3.This certificate shall remain valid from [dd/mm/yyyy] until [dd/mm/yyyy ()] subject to compliance with the requirements of Part-MED/Part ATCO.MED (2) unless it has been surrendered, superseded, suspended or revoked.

Date of issue: dd/mm/yyyy Signature: [Competent Authority]

EASA Form 148 Issue 2

AERO-MEDICAL EXAMINER CERTIFICATE

Attachment () to AME certificate number:

PRIVILEGES AND SCOPE

[Name and academic title of the aero-medical examiner] 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]