PRIORITY                               ADDRESSEE
 
 
 
 
 
           FILING TIME                                                       ORIGINATOR
   
 

 
3 MESSAGES                                                         7 AIRCRAFT IDENTIFICATION         8 FLIGHT RULES    TYPE OF

                                                                           
 
   9 NUMBER                        TYPE OF AIRCRAFT                            WAKE TURBULENCE CAT          10 EQUIPMENT

                                                    
              
                    9 DEPARTURE AERODROME                                              TIME
                                              
  
   15 CRUISING SPEED                   LEVEL                                            ROUTE
                 
 


  16 DESTINATION AERODROME         TOTAL EET                     ALTN AERODROME          2ND ALT AERODROME
                     

  18 OTHER INFORMATION
 
 
 
 
                                                                                                  UHF          VHF        ELBA
    19 ENDURANCE                          PERSONS ON BOARD                                         U         V         E
                   R/                      

     SURVIVAL
    EQUIPMENT    POLAR      DESERT     MARITIME    JUNGLE     JACKETS     LIGHT       FLOURES     UHF        VHF

 

S

 

P

 

D

 

M

 

J

 

J

 

L

 

F

 

U

 

V

 

 

 

 

 

 

 

 

 

 

 

 
 DINGIES                                                                                  COVER                                   
   D             NUMBER      CAPACITY                           C             COLOUR
                                           
     A            AIRCRAFT COLOUR AND MARKING
        
     N            REMARKS
        
     C             PILOT IN COMMAND
        
  
     FILED BY                                              SPACE RESERVED FOR ADDITIONAL REQUIREMENTS