MINISTÉRIO DA DEFESA NACIONAL - emfa.ptaan.emfa.pt/includes/AAN/conteudos/galeria/ficheiros/autorizacoes/f… · MINISTÉRIO DA DEFESA NACIONAL AUTORIDADE AERONÁUTICA NACIONAL DIPLOMATIC
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REPÚBLICA PORTUGUESA M I N I S T É R I O D A D E F E S A N A C I O N A L
AUTORIDADE AERONÁUTICA NACIONAL
DIPLOMATIC CLEARANCE NOTIFICATION OR REQUEST FORM
1 – Call Sign: 2 – Sending State:
3 – Number of Aircraft / Type / Registration:
4 – Blanket Diplomatic Clearance (DCN) if any:
5 – Spare aircraft: 6 –Aircraft Operator:
7 – Purpose of flight:
8 – Aircraft commander’s name and rank, as well as, number and nationality of the crew members:
9 – Number of passengers and nationality (name and title/functions of any VIP on board):
10 – Technical data:
Date of
flight
Airfield of
origin (ICAO)
Last airfield (ICAO) before
Portugal and ETD (HHMM)
Entry point inPortuguese FIR’S (report point or LAT/LONG) and ETO
Portugueseairfield requested
(if any) and
ETA / ETD
Exit point of Portuguese FIR’S (report point or LAT/LONG) and ETO
First airfield (ICAO) after Portugal and ETA (HHMM)
Destination airfield (ICAO)
11 – Route to be flown in Portugal, including reporting points and airways or geographic coordinates (Latitude/Longitude):
12 – Alternate airfields in Portugal (if any):
13 – Other information: A. Will the aircraft transport Any Items included in United Nations List of Dangerous Goods inserted in the “Recommendations on the Transport of
Dangerous Goods”, as well as, those included in the “Common Military List” of the European Union, in force in Portugal? YES NO
If YES – Please fill out the “RISK ANALYSIS FORM”.
– Is all the cargo declared in Annex to your own use? YES NO
If NO, please send a request for a transit Permit to: Ministry of Defense Tel: +351 213 038 571 Av. Ilha da Madeira Fax: +351 213 027 221 1400‐201 Lisboa eMail: dgrdn@defesa.pt Portugal
B. Will the aircraft carry any photographic sensors or cameras, data collection equipment or electronic warfare equipment? YES NO
14 – Remarks (please use this field for any additional information):
(Signature of the Applicant)
DATE: ______/________/__________ __________________________________
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