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Name of Licence Holder… …………….

Form CA-39
Licence Class :… 1.Number … ………
2.Valid upto…………

TOTAL FLYING EXPERIENCE IN DETAIL FOR THE SIX MONTHS ending……… …200…..

Types Endor- Single Engine Aicraft with Two or More engines Total Instrument Flying
Of sed on -------------------------------------------------------------------------------------------------- ---------------------------
Air- Licence DAY NIGHT DAY NIGHT Simulated Actual
Craft yes -------------------------------------------------------------------------------------------------- %
Or Dual PIC Dual PIC Under Co- PIC Under Co- PIC
No train Pilot train Pilot
(A)1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

(B)Total
Last6months
===============================================================================================

(C)Total Flown
Till Date as
Instructor …
(E) This is to certify that I have examined the logbooks of Mr…………………………… ………… And the above is a true summary

Countersigned………………………………………………………
Name………………………………………………………………..
Designation…………………………………………………………
Signature of Licence Holder…………………………….. Company……………………………………………………………
Date……………… Date…………………………………………………………………
% indicates Simulated – Link/Hood Flying/Instrument Flying with safety Pilot

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