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 |
| FLIGHT SUMMARY INFORMATION - please select arrival or departure as appropriate |
| NOTICE OF ARRIVAL |
| Aircraft Tail Number | |
Departure Country | |
| Departure Airport (ICAO) | |
| Departure City | |
| Departure Date MM/DD/YYYY | |
| ETD Local Time (0001 - 2400) HH/MM | |
| Foreign Airports Landed Within 24 Hours of Departure (ICAO) | |
| Estimated Time and Location Crossing US Border or Coastline (UTC) | |
| US Arrival Airport (ICAO) | |
| US Arrival Date MM/DD/YYYY | |
| ETA Local Time (0001 - 2400) HH/MM | |
| US Arrival City | |
| US Arrival State | |
Parking Location at Arrival Airport e.g. FBO, Private Hangar, etc. | |
| 24 Hour Emergency Contact Last Name | |
| 24 Hour Emergency Contact First Name | |
| 24 Hour Emergency Contact Middle Name | |
| 24 Hour Emergency Contact Telephone Number | |
| 24 Hour Emergency Contact E-Mail Address | |
| Number of Crew | |
| Number of Passengers | |
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| NOTICE OF DEPARTURE |
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| AIRCRAFT DETAILS |
| 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 Location (City & ICAO ident) | |
| Engine Type and Dash Number | |
| MTOGW (lbs.) | |
| Zero Fuel Weight (lbs.) | |
| Basic Empty Weight BEW/BOW (lbs.) | |
| Service Ceiling | |
| Maximum Fuel in Pounds | |
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RVSM/MNPS EQUIPMENT INFORMATION and
LONG RANGE NAVIGATION AND COMMUNICATIONS SYSTEMS |
| Qty. | Type of Equipment | Manufacturer | Part No. |
| Autopilot | | |
| Transponder | | |
| TCAS | | |
| EGPWS/GPWS | | |
| GPS | | |
| INS | | |
| IRU/IRS | | |
| LORAN | | |
| VHF 8.33 KhzYesNo | | |
| HF | | |
| SATCOM | | |
| SELCAL CODE: | | |
| MAINTENANCE |
| Airworthiness Directive's (AD's) Not Complied With | |
| Inspections Out of Date | |
| Inspections Due | |
| Ferry Permit Applied For | YesNo |
| Ferry Tanks Installed | YesNo |
| Import/Export Permits Applied For | YesNo |
| TRIP DETAILS |
| Departure Airport (City, Airport Name, ICAO ident) | |
| Destination Airport (City, Airport Name, ICAO ident) | |
| Requested Departure Date | |
| Do You Currently Have Insurance | YesNo |
| Comments: |
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