INAC – Departamento de Licenciamento de Pessoal e Formação

Rua C - Edifício Santa Cruz - Aeroporto da Portela

1749-034 Lisboa – PORTUGAL

PPL (A) Skill test

1) Preencher preferencialmente por via eletrónica, caso contrário deve utilizar letras MAIÚSCULAS com tinta azul ou preta
Preferably complete electronically, otherwise use CAPITAL letters with blue or black ink
2) Examinador em supervisão, referir em “C3” e preencher “DLPF Form 003” Examiner under supervision mention in “C3” and fill the form “DLPF Form 003”

Nome do candidato: Nº de licença:

Applicant´s name ....….…………………………………………………………………………………………………………………………………………………………….. Licence number …………………………………..……………………………
Nome da ATO: Número de Certificado ATO:
Name of ATO ……………………..…………………………………………...……………………..….……………………… Certificate number of ATO ….…………………………………..……………………..….………………………

De LAPL(A) From LAPL(A)

Prova de voo inicial Initial Skill test De LAPL(S) com TMG From LAPL(A) with TMG
Outra categoria, exceto balões Another category except balloon
Repetição de exame de voo com aprovação parcial Repetition of partial passed skill test efetuado na data: dd/mm/yyyy
Repetição de exame de voo Repetition of failed skill test from date ………………………………..

Em anexo envia-se certificado/outro documento comprovativo. A preencher pelo Diretor de Instrução

A - Declaração da ATO ATO declaration Certificate/another document in attachment. To be completed by the Head of Training

A organização de formação confirma que o candidato cumpriu o programa teórico e treino de voo aprovado de forma satisfatória.
I confirm that the experience of the applicant comply with the applicable requirements of Part-FCL
Nome do DI: Assinatura do DI:
HT´s name …………………………………….………………………………………………………………………………….. HT´s Signature ………….……………………………………………………………………………………..……………

Only for NON-INAC EXAMINERS

B - National Procedures Declaration To be completed by the examiner

“I hereby declare that I, (complete name) ………………………………..………………………………………………………….…………………………………………………………………………………………………………………………..

have reviewed and applied the relevant national procedures and requirements of the applicants Competent Authority contained in version
…….…..….………………………………………..…
of the Examiner Differences Document.” Examiner´s signature:
.………………..………………………………….…………………………………………………

A preencher pelo examinador

C1 - Detalhes da verificação Check details To be completed by the examiner
Data Modelo de avião Matrícula Tempo total
Date Aeroplane model Registration Total time
dd/mm/yyyy hh:mm
……………………………….. ……………………………….. ……………………………….. ………………………………..
Aeródromo de partida Aeródromo de destino Hora de descolagem Hora de aterragem Descolagens Aterragens
Departure Destination Take-off time Landing time Take-offs Landings
hh:mm hh:mm
……………………………….. ……………………………….. ……………………………….. ……………………………….. ……………………………….. ……………………………….
* Mencionar razão para os itens reprovados, referir em “C3” A preencher pelo examinador
C2 - Resultado da verificação Check result * Mention reasons for failed items in “C3” To be completed by the examiner

Apto Não apto * Parcialmente apto * Assinatura do candidato:

Pass Fail * Partial pass * Applicant´s signature ……………………………………………………..………………
A preencher pelo examinador
C3 - Observações Remarks To be completed by the examiner

.……………………………………………………………………………………………………………………………………………………………………………………………………………………………………
.……………………………………………………………………………………………………………………………………………………………………………………………………………………………………
.……………………………………………………………………………………………………………………………………………………………………………………………………………………………………
.……………………………………………………………………………………………………………………………………………………………………………………………………………………………………
A preencher pelo examinador
C4 - Declaração do Examinador Examiner Declaration To be completed by the examiner
Confirmo que a experiência do candidato cumpre com os requisitos aplicáveis da Part-FCL.
I confirm that the experience of the applicant comply with the applicable requirements of Part-FCL
Confirmo que as manobras e exercícios requeridos foram completados.
I confirm that the required manoeuvres and exercises have been completed
Nome: Número de certificado de examinador:
Name ………………………………………………………………………………………………………………………………… Examiner´s certificate number ………………………………………………………….………

Local e data: Assinatura do examinador:

Location and date ………………………………………………………………………………………………………………… Examiner´s signature .……………………………………….……………………………………………………

Revision Date
DLPF Form 015 14/04/2014 Page 1/4
 INAC – Departamento de Licenciamento de Pessoal e Formação
Rua C - Edifício Santa Cruz - Aeroporto da Portela
1749-034 Lisboa – PORTUGAL

PPL (A) Skill test

Examiner INAC
PPL (A) – General requirements: Requirements Fill by ATO
Check only
Applicant minimum age 17 years Age: ……………………………………………. □ ⃝
Document of identification Copy ⃝
EASA Medical Certificate Class 2 Valid until: ………………………………….. □ ⃝
Theoretical examination PPL (A) Passed Date: ………………. Rate: ……………….. □ ⃝
English Language Test for Aviation Level 4 Level: …….. Valid until: ……………….. ⃝
Logbook filled and signed Logbook Total hours: ………………………………… □ ⃝
Chose the applicable (PPL(A) or PPL (A) - Holder LAPL (A) or PPL (A) - Holder LAPL (S) with a TMG extension)
Examiner INAC
PPL (A) Requirements Fill by ATO
Check only
Crediting “Crediting”
1) License another category of aircraft Max 10 % License: …….………. Valid: …….………. ⃝
Credit given: .…….……………………….. ⃝
Flight experience Min 45 H Hours: ………………………………………… □ ⃝
Instrument ground time FSTD Max 5 H Hours: ………………………………………… □ ⃝
1) Dual flight instruction Min 25 H Hours: ………………………………………… □ ⃝
2) Solo flight time Min 10 H Hours: ………………………………………… □ ⃝
a) Solo cross-country flight Min 5 H Hours: ………………………………………… □ ⃝
i) Solo flight 270 Km Date: ………………………………………….. □ ⃝
(1) Full stop landings at 2 DEP 1 …………….……… DEST 1 ……………….…… KM ……….…… □ ⃝
aerodromes different DEP 2 ………….………… DEST 2 ………….………… KM ……….…… □ ⃝
from the aerodrome of
departure
Crediting. Applicants holding a pilot licence for another category of aircraft, with the exception of balloons, shall be credited with 10 % of their total flight time as PIC
on such aircraft up to a maximum of 10 hours. The amount of credit given shall in any case not include the requirements in “Solo flight time”

Examiner INAC
PPL (A) - Holder LAPL (A) Requirements Fill by ATO
Check only
1) License LAPL (A) Hold Valid until: ………………………………….. ⃝
Flight experience
1) Flight time Min 15 H Hours: ………………………………………… □ ⃝
2) Flight instruction (ATO) Min 10 H Hours: ………………………………………… □ ⃝
a) Supervised solo flight time Min 4 H Hours: ………………………………………… □ ⃝
i) Solo cross-country flight Min 2 H Hours: ………………………………………… □ ⃝
(1) Solo flight 270 Km Date: ………………………………………….. □ ⃝
(a) Full stop landings DEP 1 …………….……… DEST 1 ……………….…… KM ……….…… □ ⃝
at 2 aerodromes DEP 2 ………….………… DEST 2 ………….………… KM ……….…… □ ⃝
different from the
aerodrome of
departure
PPL (A) - Holder LAPL (S) Examiner INAC
Requirements Fill by ATO
with a TMG extension Check only
1) License LAPL(S) + TMG Hold Valid until: ………………………………….. ⃝
Crediting “Remarks”
1) License another category of aircraft Max 10 % License: …….………. Valid: …….………. ⃝
Credit given: .…….……………………….. ⃝
Flight experience
1) Flight time on TMG Min 24 H Hours: ………………………………………… □ ⃝
2) Solo flight time Min 10 H Hours: ………………………………………… □ ⃝
a) Solo cross-country flight Min 5 H Hours: ………………………………………… □ ⃝
i) Solo flight 270 Km Date: ………………………………………….. □ ⃝
(a) Full stop landings DEP 1 …………….……… DEST 1 ……………….…… KM ……….…… □ ⃝
at 2 aerodromes DEP 2 ………….………… DEST 2 ………….………… KM ……….…… □ ⃝
different from the
aerodrome of
departure
Crediting. Applicants holding a pilot licence for another category of aircraft, with the exception of balloons, shall be credited with 10 % of their total flight time as PIC
on such aircraft up to a maximum of 10 hours. The amount of credit given shall in any case not include the requirements in “Solo flight time”
Local e data Assinatura do examinador:
Location and date …………………………………………………………………………………………………………………… Examiner´s signature .……………………………………….…………………………………………….

Revision Date
DLPF Form 015 14/04/2014 Page 2/4
 INAC – Departamento de Licenciamento de Pessoal e Formação
Rua C - Edifício Santa Cruz - Aeroporto da Portela
1749-034 Lisboa – PORTUGAL

PPL (A) Skill test

Nome do candidato:
Applicant´s name ……………………………………………………….….………………………………………………………………………………………..

SECTION 1 — PRE-FLIGHT OPERATIONS AND DEPARTURE

Use of checklist, airmanship, control of aeroplane by external visual reference, anti/de-icing procedures, etc. apply in all Pass Fail
sections
a Pre-flight documentation, NOTAM and weather briefing
b Mass and balance and performance calculation
c Aeroplane inspection and servicing
d Engine starting and after starting procedures
e Taxiing and aerodrome procedures, pre-take-off procedures
f Take-off and after take-off checks
g Aerodrome departure procedures
h ATC compliance and R/T procedures

SECTION 2 — GENERAL AIRWORK Pass Fail

a ATC compliance and R/T procedures
b Straight and level flight, with speed changes
Climbing:
i) Best rate of climb;
c
ii) Climbing turns;
iii) Levelling off.
d Medium (30 ° bank) turns
e Steep (45 ° bank) turns (including recognition and recovery from a spiral dive)
f Flight at critically low air speed with and without flaps
Stalling:
i) Clean stall and recover with power;
g

iii) Approach to stall in landing configuration.

Descending:
i) With and without power;
h
ii) Descending turns (steep gliding turns);
iii) Levelling off.

SECTION 3 — EN-ROUTE PROCEDURES Pass Fail

a Flight plan, dead reckoning and map reading
b Maintenance of altitude, heading and speed
c Orientation, timing and revision of ETAs and log keeping
d Diversion to alternate aerodrome (planning and implementation)
e Use of radio navigation aids
f Basic instrument flying check (180 ° turn in simulated IMC)
g Flight management (checks, fuel systems and carburetor icing, etc.)
h ATC compliance and R/T procedures

SECTION 4 — APPROACH AND LANDING PROCEDURES Pass Fail

a Aerodrome arrival procedures
b* Precision landing (short field landing), crosswind, if suitable conditions available
c* Flapless landing
d* Approach to landing with idle power (SE only)
e Touch and go
f Go-around from low height
g ATC compliance and R/T procedures
h Actions after flight
* These items may be combined, at the discretion of the FE.
Local e data Assinatura do examinador:
Location and date …………………………………………………………………………………………………………………… Examiner´s signature .……………………………………….…………………………………………….

Revision Date
DLPF Form 015 14/04/2014 Page 3/4
 INAC – Departamento de Licenciamento de Pessoal e Formação
Rua C - Edifício Santa Cruz - Aeroporto da Portela
1749-034 Lisboa – PORTUGAL

PPL (A) Skill test

Nome do candidato:
Applicant´s name ……………………………………………………….….………………………………………………………………………………………..

SECTION 5 — ABNORMAL AND EMERGENCY PROCEDURES Pass Fail

This section may be combined with sections 1 through 4
a Simulated engine failure after take-off (SE only)
b* Simulated forced landing (SE only)
c Simulated precautionary landing (SE only)
d Simulated emergencies
e Oral questions

SECTION 6 — SIMULATED ASYMMETRIC FLIGHT AND RELEVANT CLASS OR TYPE ITEMS Pass Fail
This section may be combined with sections 1 through 5
a Simulated engine failure during take-off (at a safe altitude unless carried out in an FFS)
b Asymmetric approach and go-around
c Asymmetric approach and full stop landing
d Engine shutdown and restart
e ATC compliance, R/T procedures or airmanship
As determined by the FE: any relevant items of the class or type rating skill test to include, if applicable:
i) Aeroplane systems including handling of auto pilot;
f
ii) Operation of pressurisation system;
iii) Use of de-icing and anti-icing system.
g Oral questions
* These items may be combined, at the discretion of the FE.
Local e data Assinatura do examinador:
Location and date …………………………………………………………………………………………………………………… Examiner´s signature .……………………………………….…………………………………………….

Revision Date
DLPF Form 015 14/04/2014 Page 4/4