Federal Public Service Mobility and Transport

Belgian Civil Aviation Authority - BCAA

Operations Directorate

APPLICATION FORM – Initial or Variation application for

Air Operator Certificate (AOC) and/or Operations Specifications (OS)

This application form must be in possession of the Belgian CAA at least:

 90 days before the intended date of beginning of the planned operations,
 30 days in case of variation of an existing AOC and/or Operations specifications,
 10 days before the change(s) of post-holder(s) 1.
To be returned to BCAA Operations at : ops.queries@mobilit.fgov.be
This application AOC and/or OS concerns:
☐ Initial (first issue of AOC or new OS) or
☐ Variation (change of AOC or OS).

A. VARIATION: REASON(S) OF THE CHANGE

☐ Aircraft type already operated by the AOC Holder
Aircraft to be added to OS ☐ New aircraft type (not already operated by the AOC Holder)

The amount of crew members to operate the fleet of aircraft type:

(e.g.: ETOPS, area of operations, PBN, …)

OS change2

B. AIRCRAFT DETAILS
Aircraft Manufacturer information
Type/Mark
MSN
Registration
Date(s) available for inspection
Date of the first commercial flight
Name of the previous operator
Registration in the previous
operator

C. CONTACT DETAILS 2
Operator name
Trading as
AOC number if available
Addresses (headquarters, base(s))
Phone number(s)
email(s)

D. OPERATOR’S STAFF 1,2

Manager Name e-mail phone number
Accountable
Flight Operations
Ground Operations
Crew Training
Continuing Airworthiness

OPS Procedures Form 1119 issued 12/01/2018 Page 1/4

 Federal Public Service Mobility and Transport
Belgian Civil Aviation Authority - BCAA
Operations Directorate

Compliance Monitoring
Safety

BCAA
E. MANUALS & DOCUMENTATION 2 check
Ed/Rev/
Detail(s) & Evidence(s) Issue date Annex ref/number Y N N/A
(dd/mm/yyyy)
OM Part A ☐ ☐ ☐
OM Part B ☐ ☐ ☐
MEL adapted (if applicable) ☐ ☐ ☐
OM Part C ☐ ☐ ☐
OM Part D ☐ ☐ ☐
Cabin Crew/Attendant Manual (CAM or
SEP) ☐ ☐ ☐
EFB (PPM) ☐ ☐ ☐
Ground OPS Manual ☐ ☐ ☐
CMM (if separate from OM-A) or MSM ☐ ☐ ☐
SMM or MSM ☐ ☐ ☐
Management of Change (MOC) ☐ ☐ ☐
FDM (statement & evidence of effectivity) ☐ ☐ ☐
(Cabin) Safety Briefing Card(s) ☐ ☐ ☐
Relevant manufacturer manuals (AFM, Pilot
Operating Handbook, FCOM, QRH, FCTM, ☐ ☐ ☐
FAM…) & MMEL.
STC, AD and MOD concerning the aircraft ☐ ☐ ☐
AFM supplement(s) ☐ ☐ ☐
Type certificate Data sheet of the concerned
aircraft (including supplemental TCDS) ☐ ☐ ☐
EASA OSD ☐ ☐ ☐
Differences in aeroplane/STD and/or
aeroplanes equipment covered by
documents (in support for the differences ☐ ☐ ☐
and familiarisation training of crews)
Determination of the Dry Operating Mass
and Centre of Gravity (DOM & cg) based on ☐ ☐ ☐
the Basic Empty Mass
Cabin layout with type and location of safety
equipment on board ☐ ☐ ☐
Compliance checklist AIR-OPS regulation Form 1193 ☐ ☐ ☐
Copy of the certificate of registration ☐ ☐ ☐
Copy of the certificate of airworthiness ☐ ☐ ☐
Copy of the noise certificate ☐ ☐ ☐

OPS Procedures Form 1119 issued 12/01/2018 Page 2/4

 Federal Public Service Mobility and Transport
Belgian Civil Aviation Authority - BCAA
Operations Directorate

Copy of the Lease contract ☐ ☐ ☐

Copy of the insurance ☐ ☐ ☐
Management Of Change / Risk assessment ☐ ☐ ☐
Security programme (AMC1 ORO.AOC.100(a)) ☐ ☐ ☐

BCAA
F. OPERATIONS SPECIFICATIONS 4 check
Types of operations: ☐ Passengers ☐ Cargo ☐ Others:
Commercial air ☐
transport:
Area of operation: Name ☐
Special Limitations: / ☐
Specific Approvals: Yes No Specification Remarks²/3
Dangerous Goods ☐ ☒ ☐
Low Visibility Operations Application form
1161
Take-off ☐ ☒ RVR: m ☐
Approach and Landing ☐ ☒ LTS CAT I RVR: m DA: ft ☐
☐ ☒ CAT II RVR: m DH: ft ☐
☐ ☒ OTS CAT II RVR: m DH: ft ☐
☐ ☒ CAT IIIA RVR: m DH: ft ☐
☐ ☒ CAT IIIB RVR: m DH: ft ☐
☐ ☒ CAT IIIC RVR: m DH: ft ☐
RVSM ☐ N/A ☐ ☒
Application form
☐
1123
ETOPS ☐ N/A ☐ ☒
Maximum Diversion Time: min.
☐
NM ; Engine :
Complex navigation
specifications for PBN ☐ ☒ ☐
Operations
Minimum navigation Application form
performance ☐ ☒ 1199 ☐
specification
Helicopter operations
with the aid of night ☐ ☒ ☐
vision imaging systems
Operations of single-
engined turbine
☐ ☒ ☐
aeroplane at night or in
IMC (SET-IMC)
Helicopter hoist
☐ ☒ ☐
operations
Helicopter emergency
medical service ☐ ☒ ☐
operations
Helicopter offshore (HOFO from
☐ ☒ 01/07/18) ☐
operations
Cabin crew training ☐ ☒ ☐
Issue of CC attestation ☐ ☒ ☐

OPS Procedures Form 1119 issued 12/01/2018 Page 3/4

 Federal Public Service Mobility and Transport
Belgian Civil Aviation Authority - BCAA
Operations Directorate

Continuing airworthiness ☐ ☒ ☐

Others

Steep approach ☐ ☒ ☐
Aircraft used for non-
☐ ☒ ☐
commercial operations
Max distance from an
adequate aerodrome for
☐ ☒ ☐
two-engined aeroplanes
without ETOPS approval
Short landing operations ☐ ☒ ☐
Operations with
☐ ☒ ☐
increased bank angles
CPDLC ☐ ☒ ☐
Isolated aerodrome ☐ ☒ Approved aerodromes: ☐
EFB Application form
☐ ☒ ☐
1163
Helicopter operations approved sites listapproved sites list
to/from a public interest ☐ ☒ ☐
site
Helicopter operations (CAT.POL.H.420)
over a hostile
☐ ☒ ☐
environment located
outside a congested area
Helicopter operations
without a safe forced ☐ ☒ ☐
landing capability
Helicopter offshore (National
operations ☐ ☒ requirements until ☐
01/07/18)

NAME & Signature of the Accountable Manager : NAME & Signature of the Compliance Monitoring Manager :

Date of signature (dd/mmm/yyyy) : Date of signature (dd/mmm/yyyy) :

Number of attached annexes :

1 Curriculum vitae form (BCAA Procedures form 1118) completed to be annexed

2 Fill in only for changed document/situation, when applicable or enter “N/A”
³ Evidence(s) and/or statement from the manufacturer (or modification holder) documentation
4 Insert specifications applied for

OPS Procedures Form 1119 issued 12/01/2018 Page 4/4