Professional Aviation Services

2152 Astoria Circle # 104
Herndon, VA 20170
Fax 703 657-0340

Please fill out this form as completely as possible. If you don't know some of the information, we will work with you to get what is needed. The FAA requires specific operator and aircraft information to process your application for a RVSM Letter of Authorization (LOA). By completing this form, we will have the necessary information.
e-APIS INFORMATION - AFTER SELECTING DEPARTURE OR ARRIVAL NOTIFICATION AS APPROPRIATE, ALL FIELDS ON THIS FORM ARE MANDATORY FOR U.S. CUSTOMS CLEARANCE - ANY FIELDS LEFT BLANK CONSTITUTES DENIAL OF THE CLEARANCE
Customer Name
Primary Contact Name
Contact's e-mail
Contact's Business Phone Number
Contact's Cell Phone Number
Contact's Fax Number
Billing Address
Delivery Address
Name on A/C Registration
PERSON RESPONSIBLE FOR MAINTENANCE OPERATIONS
Name
Title
Business Phone Number
Cell Phone Number
Fax Number
E-Mail Address
Delivery Address
RVSM APPLICATION INFORMATION
Areas of Operation:				Check Areas of Operation Requested:
North Atlantic Minimum Navigation Performance Specification (NAT MNPS) with Reduced Vertical Seperation Minimum (RVSM)
West Atlantic Route System (WATRS) with RVSM
North Pacific, Central East Pacific Airspace with RVSM (NOPAC/CEPAC RNP-10)
Domestic RVSM (DRVSM)
A/C Make and Model
A/C Year of Manufacture
A/C Registration Number
A/C Serial Number
A/C Base Color and Trim Color
A/C Base of Operation (ICAO Code, City, State, Zip Code)
PERSON RESPONSIBLE FOR CREW TRAINING
Must be a U.S. Citizen or Hold a Valid U.S. Pilot License
Name
Title
Business Phone Number
Cell Phone Number
Fax Number
E-Mail Address
Delivery Address
RVSM CERTIFICATION INFORMATION
Was A/C Manufactured RVSM Compliant? Yes No if no,
RVSM Completed by:
Vendor or Maintenance Facility
Contact Name
Contact Cell Phone Number
Business Phone Number
Fax Number
Contact E-Mail Address
Facility Website or E-Mail Address
Mailing Address
Date Completed
Comments:

MAINTENANCE OF RVSM EQUIPMENT
Maintenance Facility
Contact Name
Contact Cell Phone Number
Business Phone Number
Fax Number
Contact E-Mail Address
Facility Website or E-Mail Address
Mailing Address
Certified Repair Station Number
RVSM/MNPS EQUIPMENT INFORMATION and LONG RANGE NAVIGATION AND COMMUNICATIONS SYSTEMS
If Any Equipment is Part of an Integrated Unit, Please State Which Units are Included in the Same Part Number
Qty.	Type of Equipment	Manufacturer	Part Number
	Autopilot
	Primary Altimetry (Altimeters and/or EFIS)
	Air Data Computers
	Altitude Alerter
	Transponder
	TCAS
	EGPWS/GPWS
	GPS
	INS
	IRU/IRS
	LORAN
	VHF 8.33 KhzYesNo
	HF
	SATCOM
	SELCAL CODE:
COPIES OF THE FOLLOWING DOCUMENTS WILL BE REQUIRED
Registration Airworthiness Certificate Radio Station License FAR 91.411 FAR 91.413 RVSM STC, SB, or ASC (Group Approval or the one off the airframe) RVSM Equipment STC Logbook Entries for RVSM Installation FAA Form 337 for RVSM Installation, if applicable Instructions for Continued Airworthiness (Airframe) Instructions for Continued Airworthiness (Equipment) Airplane Flight Manual Supplement (RVSM, FMS, GPS, TCAS II, and for Single Pilot Airplanes, AFM Supplement for Single Flight Director, if applicable) Flight Crew Training Records (RVSM & International Operations) Flight Crew Pilot License Flight Crew Medical Certificate Flight Crew Radiotelephone License