Section/division: Personnel Licensing Form Number: CA 61-91

Telephone number: 011-545-1000/1158/1157/1499

Physical address: Ikhaya Lokundiza, 16 Treur Close, Waterfall Park, Bekker Street, Midrand, Gauteng
Postal address: Private Bag X73, Halfway House 1685 Website: www.caa.co.za
DETAILS OF BANK ACCOUNT FOR PAYMENT OF PRESCRIBED FEE
Account Number:
Bank: Standard Bank of SA Ltd Branch: Brooklyn, Pretoria Branch Code: 011245 013007971 Email: exams@caa.co.za
COMPULSORY CLIENT PAYMENT CODE (to be completed on deposit slip)
Service/transaction Over the counter payments EFT, Internet, Wire, Electronic payments
ENTRY ONLINE
EXAMS

ENTRY FOR ONLINE EXAMINATION

Note: One copy to be handed in at the examination section while one is retained by
the Entrant. Examination instructions overleaf
Licence Number Expiry Date
Surname and Initials
Residential address
Postal code
Postal address
Postal code
ID number Telephone number (h)
Telephone number (w) Cellular phone number
Fax number E-mail address

CA 61-91 08 JULY 2016 Page 1 of 2

 CONDITIONS AND INSTRUCTIONS TO CANDIDATES

NOTE
The CAA has absolute confidence in the integrity of the computer examination programmer and
wishes to remind candidates that the only manner, in which an incorrect result can occur, is when a

operation of the computer mouse. If a candidate wishes to contest any result, the onus to prove an
error rests on the candidate.

WARNING:
If the rules and instructions mentioned above are contravened, candidates subject themselves to
disqualification from future examinations for a period not exceeding 36 months and the candidate
may be deemed to have failed the examination to which such contravention is applicable.
(See the RSA Civil Aviation Regulations, 2011 (SA-CAR).

1. I hereby request to enter for the examinations indicated and accept the above-mentioned
conditions.
2. I acknowledge that the Regulations apply to the conduct of this examination(s).
3. I acknowledge that examination fraud and cheating are regarded as serious offences.

SIGNATURE OF CANDIDATE NAME IN BLOCK LETTERS DATE

SIGNATURE OF
NAME IN BLOCK LETTERS DATE
EXAMINATION OFFICER
Receipt Date y y y y m m d d Receipt No.
Entry Confirmed YES NO

CA 61-91 08 JULY 2016 Page 2 of 2