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RAANZ Inc
Freepost 102829
PO Box 15016, Hamilton 3243
office@raanz.org.nz
07 825 2800
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Fit and Proper Person Declaration

FPP No:

The information solicited herein is required pursuant to Sections 9 and 10 of the Civil Aviation Act 1990,
which requires a Fit and Proper Person test to be satisfied.

Applicant Details
Name
Address
Place of Birth Date of Birth

1- Have you previously had an application for an Aviation Document rejected, or have you been the holder of an Aviation Document that has been suspended or revoked (other than a licence that has been superseded by a replacement or higher license)?
No
Yes

2- Do you currently hold an Aviation Document (RAANZ, SAC, Part 61, LAME, other)
No
Yes

3- Have you been convicted in any court of law of any transport safety offence in the last five years, or are you currenty facing charges for a transport safety offence ?
No
Yes

4- Have you been convicted on any criminal charge, or are you presently facing charges for any criminal offence?
No
Yes

5- Have you any history of physical or mental health or serious behavioural problems?
No
Yes

DECLARATION
I certify that to the best of my knowledge and belief the statments made and the information supplied in this declaration are correct. I hereby consent to the disclosure by the New Zealand Police to RAANZ of any details of any convictions I may have pursuant to this application,. I will advise RAANZ of any change or event affecting my Fit & Proper Person status.
Signed:
Date:
The provision of false information or failure to disclose information relevant to the grant or holding of an Aviation Document constitutes an offence under Section 49 of the Civil Aviation Act 1990 and is subject, in the case of an individual, to imprisonment for a term not exceeding 12 months or a fine not exceeding $5000.
(C) 2014 RAANZ Revision date May 2014