Fit and proper person form

Fit & Proper Person Declaration

RAANZ PO Box 15016 Hamilton 3240  021 076 3483  admin@raanz.org.nz

The information solicited herein is required pursuant to the Civil Aviation Act , which provides for a Fit and Proper person test to be satisfied.

Name
Address

Have you previously had an application for an aviation document rejected or have you been the holder of an aviation document which
has been suspended or revoked (other than a license that has been superseded by a replacement or a higher license)?

Answer:

Do you currently hold an aviation document. (RAANZ, Part 61, Engineer or other)?

Answer:

Have you been convicted in any court of law of any transport safety offense in the last five years or are you presently facing charges
for a transport safety offense?

Answer:

Have you been convicted on any criminal charge or are you presently facing charges for any criminal offense?

Answer:

Have you any history of physical or mental health or serious behavioral problems?

Answer:

DECLARATION

• I hereby certify that to the best of my knowledge and belief the statements made and the information supplied in
this questionnaire and the attachments 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

The provision of false information or failure to disclose information relevant to the grant or holding of an aviation document constitutes
an offense under the Civil Aviation Act and is subject, in the case of an individual, to imprisonment for a term not exceeding 12 months
or to a fine not exceeding $5,000.