Accredited Medical Conclusion
Request for Identification of Experts
CAA Form 24067-300 - May 03
- Adobe Acrobat PDF Version- Print out, fill-in, sign, and post or fax
- Microsoft Word Version (49 KB) - Print out, fill-in, sign, and post or fax
- Fillable Form Microsoft Word Version (54 KB)- Complete on PC, Print out, sign, and post or fax
Instructions for using the Fillable Form Microsoft Word Version
Use of this form requires a compatible version of Microsoft Word. The form is designed be filled-in on your personal computer - prior to printing, signing, and then faxing or posting the completed form to the CAA.
The form has ten places where information can be selected or entered. These fields will appear shaded.
- Applicant name. Select the field showing "I M N Applicant" and type in the details required.
- Applicant Client No. Select the field showing "12345" and type in the details required.
- Class(es) of medical certificate sought. These three fields, showing "Class 1", "Class 2", and "Class 3" are pull-down menus which each offer the choice of medical certificate class and a hyphen "'-". Use the pull-down menus to indicate the Class, or Classes of medical certificate being sought (eg If a Class 2 certificate is being sought, then "Class 2" can be selected in the first menu and the hyphen can be selected in the other two. If both Class 1 and Class 2 certificates are sought, then "Class 1" can be selected in the first menu, "Class 2" in the second, and the hyphen in the third.)
- See above.
- See above.
- Date of application for medical certificate. Select the field showing "01 April 2003" and type in the details required. The date format required is the format shown (12 September 2002, 10 July 2004, 07 February 2003, etc).
- Date of this request. Select the field showing "02 April 2003" and type in the details required. The date format required is the format shown (12 September 2002, 10 July 2004, 07 February 2003, etc).
- Medical conditions and likely aviation medical issues. Select the data entry field and type in the details required. This field will automatically expand to accommodate as much text as you wish to enter.
- Availability and willingness to be an AMC expert. This small pull-down menu can be found at the start of the first line of the final paragraph of the form. You can select either "am" or "am not" to indicate whether you are available and willing to be an expert for the Accredited Medical Conclusion, should the Director wish to identify you for that purpose. If you make no selection "am not" will show as the default.
- Name and address. You can either type in your practice details here, or delete the text that is already there and use your practice stamp on the printed document.