MINISTRY OF TRANSPORTATION

DIRECTORATE GENERAL OF CIVIL AVIATIONS

DIRECTORATE OF AIRWORTHINESS AND AIRCRAFT OPERATION
Office Complex Soekarno-Hatta International Airport, C3 St., Tangerang, Banten- Indonesia
Telp.: (+6221) 225 66288, (+6221) 256 08887 Fax. : (+6221) 225 66399
Website : hubud.dephub.go.id; e-mail: daao_dgca@dephub.go.id

ORAL & PRACTICAL TEST

I. TEST APPLICATION
LICENSE CATEGORY TYPE RATING
 A1.3  A2.3  A1.4  A2.4

C

II. APPLICANT INFORMATION

NAME: DATE OF BIRTH: AGE: SEX:
/ / M F
PLACE OF BIRTH: ID OR PASSPORT NO.: NATIONALITY:

EMPLOYER OR ORGANIZATION NAME:

III. EXAMINER REPORT

APPLICANT VERIFICATION
SUBJECT SAT UNSAT N/A

1. Applicant Identification   
2. AMEL or Basic Certificate   
3. Certificate of Aircraft Type Training   
4. Schedule of Type Experience (DAAO Form No. 65-16)   
 PASS  FAIL
ORAL TEST
SUBJECT SAT UNSAT N/A

Determine that the applicant have knowledge in the following subject:

1. Aircraft Maintenance Engineer License privileges and limitations   
2. Maintenance Publications including Type Certificate, TCDS, CAMP,
Aircraft Maintenance Manual, AD, Service bulletins, and etc.   
3. Aircraft Documents including Certificate of Registration, Certificate of
Airworthiness, Weight & balance, Maintenance Logbook, MEL, and
etc.   
4. Identify safety precautions related to the airframe, its system and
poweplant.   
5. Identify maintenance practice important to the airframe, its system
and poweplant.   
6. Define the general layout of the aircraft’s major system.   
7. Define the general layout and characteristics of the powerplant.   
8. Describe systems and aircraft handling particularly access, power
  
availability and sources.
9. Identify the locations of the principle components for the aircraft
  
system described above.
10. Explain the normal functioning of each major system, including
  
terminology and nomenclature.
 PASS  FAIL
DGCA Form No. 65-18 (May 2018) Page 1 of 2
PRACTICAL TEST
SUBJECT SAT UNSAT N/A
Determine that the applicant have Demonstrated skill to perform:
1. Ramp and transit servicing associated with the aircraft for the
following systems: Fuel, powerplant, hydraulics, landing gear, and   
oxygen.
2. System, engine, component and functional check as specified in
  
maintenance manual.
3. Troubleshooting & Approval for Return To Service
• Identify Fault   
• Determine the fault isolation task   
• Determine the possible causes the fault   
• Identify and use appropriate document   
• Correlate information for the purpose of making decisions in
respect of fault diagnosis and rectification to maintenance   
manual level.
• Perform maintenance actions should be taken   
• Determine are there references of MEL and what interval   
• Demonstrate proficiency in use of aircraft or maintenance log
  
and determine the aircraft is airworthy

 PASS  FAIL
REMARK:

I HAVE PERSONNALLY TESTED THE THE APPLICATION IN ACCORDANCE WITH PERTINENT PROCEDURES
& STANDARD, AND HAVE INDICATED THE RESULT AS
 PASS  FAIL
LOCATION DATE DESIGNATION NO. NAME & SIGNATURE

DGCA Form No. 65-18 (May 2018) Page 2 of 2