REPÚBLICA PORTUGUESA MINISTÉRIO DA DEFESA NACIONAL 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 in Portuguese FIR’S (report point or LAT/LONG) and ETO Portuguese airfield 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: [email protected] 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: ______/________/__________ __________________________________