TECHNICAL FORM MANUAL

STAMP and/ C of C ISSUE REQUEST Parent

Form: : GMF/Q-063 : QP 308-01
Procedure
Related Authority : DGCA Indonesia, FAA

STAMP / C of C / ISSUE REQUEST

Form No.: GMF/Q-063

STAMP and/or C of C ISSUE REQUEST

REQUEST, Give details below: PERSONAL DATA

INITIAL STAMP NAME :
INITIAL C of C
ID :
RENEWAL C of C
CHANGE RATING/SCOPE UNIT :
/STAMP JOB TITLE :
Specify additional information, relating to the STAMP and/or C of C request (if required):

NECESSARY REQUIREMENTS TO OBTAIN A STAMP and/or C of C

Completed by the responsible General Manager or Manager
No
DESCRIPTION
.
1 The applicant has been trained for all training required by QP-308-01 and other related QP’s
2 The applicant’s training/qualification and experience records as required by QP-308-01 and
other related QP’s available adequate and correct
3 The applicant been trained in the GMF Quality System Procedures applicable for his Job Title
The applicant follow the Quality System Procedures, technical manuals and other
4
specifications to perform his work
The applicant report his/her mistakes, report defects and unsafe conditions when necessary
5
and adequately informed about these matters
Applicant has an orientation toward quality and safety , possess good work ethics and has
6
good relations with other applicants and committed to teamwork
The applicant has been assessed against behavior and skill competencies against the
7
applicable performance criteria found in the competency charts
CERTIFICATION STATEMENT BY THE GENERAL MANAGER OR MANAGER
I certify that the above mentioned applicant complies with all requirements mentioned above
(unless not applicable) and he has been properly trained (classroom and OJT) to perform his
assigned tasks. I also certify that the applicant has been assessed as long as he was under training
and OJT for the behavior and skill competencies and found to meet the performance criteria
requirements mentioned in his Job Title and Job Grade Competency Charts and the result is good.

Date : / /
GENERAL MANAGER OR MANAGER: NAME & SIGNATURE
Day / Month / Year

Revision No.: 3 Revision Date: 03 August 2016 Page 1 of 3

Form No.: GMF/Q-361
 TECHNICAL FORM MANUAL

STAMP and/ C of C ISSUE REQUEST Parent

Form: : GMF/Q-063 : QP 308-01
Procedure
Related Authority : DGCA Indonesia, FAA

APPLICANT STATEMENTS

1. FOR WORK PERFORMED

I understand that I am authorized to perform unsupervised work only for those tasks mentioned in
my C of C. I also understand that by placing my stamp or signature on the work documents, I certify
that my self-inspected the work I have performed and that the work has been carried out in
accordance with the prevailing maintenance instructions.

2. RESPONSIBILITY STAMP CONTROL (ONLY IF REQUEST A STAMP):

I understand that by obtaining this stamp I am fully responsible for its use. I will not give my stamp
to anyone, I will keep it locked all the times and I will return it to Personnel Qualification & Quality
System Documentation when I terminated my work, transferred to a new work, revoked or
suspended. When the stamp is rotted away to a degree that the numbers are invisible, I will request
a new stamp to Personnel Qualification & Quality System Documentation. In case my stamp is lost I
will report immediately to Personnel Qualification & Quality System Documentation.

Date : / /
NAME AND SIGNATURE
Day / Month / Year
QUALIFICTION & LICENSING ASSESSOR:
I certify that I assessed the applicant and I found him competent to perform the tasks mentioned in
his C of C.

Date : / /
NAME AND SIGNATURE
Day / Month / Year
Form No.: GMF/Q-063 R3

Revision No.: 3 Revision Date: 03 August 2016 Page 2 of 3

Form No.: GMF/Q-361
 TECHNICAL FORM MANUAL

STAMP and/ C of C ISSUE REQUEST Parent

Form: : GMF/Q-063 : QP 308-01
Procedure
Related Authority : DGCA Indonesia, FAA

Instructions for completion form GMF/Q-063

Request
1. Thick the details requested as appropriate

Personal Data
2. Name
Enter the name of the personnel that participate the examination
3. ID
Enter the number of personnel
4. Unit
Enter the name of unit or department
5. Job Title
Enter the job title

Specify additional information, relating to the STAMP and/or C of C request

6. If required, enter the specify additional information relating to the STAMP and/or C of C
request

Certification statement by the general manager or manager

7. General manager or manager: name & signature
Enter the name and signature of the GM or Manager that request C of C and the date of
signature
8. Date
Enter and the date of signature

Applicant Statements
9. Name and Signature
Enter the name and signature of the participant of examination
10. Date
Enter and the date of signature
Qualification and Licensing Assessor
11. Name and Signature
Enter the Personnel qualification & licensing name & signature that examine the
participant
12. Date
Enter and the date of signature

Revision No.: 3 Revision Date: 03 August 2016 Page 3 of 3

Form No.: GMF/Q-361