|Civil Aviation Act s27B(1)
|CAR Part 67.51 - 67.55
|24067-001 Application for Medical Certificate [PDF 432 KB]
|To be completed by:
For the purpose of certification an 'Application for Medical Certificate' form must be completed. It is available here:
A non-refundable pre-payment must also be made to CAA prior to undergoing an examination. This can be made online at:
The applicant is responsible for accurately completing the Application for Medical Certificate. This should include sufficiently detailed explanations of any positive answers in the space provided after Q12 or on a separate sheet if necessary. The comment 'as previously reported' is not sufficient.
The application is to be signed and dated in front of the Medical Examiner (ME) prior to the commencement of any examination, investigation, or assessment.
The ME must ensure that the pre-payment has occurred and that the form has been completed in full prior to proceeding further with the examination.
As the application includes a declaration, it is important that the ME does not complete any part of the form on behalf of the applicant or make any changes to the entries made by the applicant. Given that the Application for Medical Certificate is the responsibility of the applicant, the ME should sign only in the final section as a witness to the applicant signing the form. The ME should ensure that the consent on the last page of the application has not been altered by the applicant.