Page 1 of 2 24061/30 Rev 1(0) : Mar 2017 Flight Test Report: Agricultural Flight Examiner Competency Demonstration (A) or (H) 1. Personal Details CAA Client Number Last Name Given Name(s) Chemical Rating expiry: Licence type (A) (H) (Appropriate) Category E Flight Instructor Rating current Yes Purpose of Test Issue Biennial Add privilege Yes N/A 2. Experience Assessment (Optional for Examiner Rating biennial) Total flight time (2500 ag ops in appropriate category) PIC (2000 in appropriate category) Flight instruction on a Part 137 aircraft (300 in category) Ag competency checks completed (10 minimum) In addition, for multi-engine privileges; (as applicable) P in C multi-engine aeroplane (300) P in C multi-engine helicopter (10) In addition, for the Examiner privilege of Category E Flight Instructor biennial competency demonstration; Flight instruction in the appropriate category of aircraft (500) 3. Particulars of Demonstration Operation type(s) Issue Grade 2 Issue Grade 1 E Cat Biennial Topdressing Spraying VTA Operational competency Aircraft Type Registration JU- Duration - Air Duration - Ground 4. Assessment of Demonstration Eligibility assessment In flight assessment Logbook assessment Debriefing Flight test briefing Knowledge of fail aspects Questioning Knowledge of remedial training required Knowledge of relevant Rules and documents Knowledge of applicable logbook entries 5. Result PASS FAIL Next Examiner Biennial demonstration of competency due: Examiner comments CAA Flight Examiner Client No Signature Date of Test Examiner training completed