Notification form Aviation

Commercial / Air Transport (English)

Fields marked with a * are required.

Personal information

Last name *

Given name *

Address *

Postal code *

Place *

Phone number *

Mobile phone number

E-mail address

Date of birth * e.g. 12-02-1973

Sex *

Function during the flight *

Other function during the flight:

Flight club

Number of flight crew licence *

Type of flight crew licence*

Ratings *

Initial issue date flight crew licence * e.g. 21-01-2004

Expiry date flight crew licence e.g. 21-01-2004

Expiry date medical certificate * e.g. 21-01-2004

Class medical certificate

Occurrence

Date of occurrence * e.g. 21-01-2004

Time of occurrence (local time) * e.g. 13:47

Place of occurrence *

Experience (in hours)

On the aircraft type involved *

During the last three months *

Total *

Information about aircraft/flight

Aircraft type *

Aircraft registration *

Owner/operator *

Transponder code

Flight number

ETOPS

Departure point *

Destination point *

Landed at

Number of passengers *

Number of crew members (cockpit/cabine)*

Flight rules *

Type of airspace *

Other type of airspace:

Purpose of flight *

Other purpose of flight:

Altitude or Flightlevel

Aircraft speed (kts)

Aircraft take-off weight

Aircraft landing weight

Flight phase *

Consequences

Other consequences:

Flight configuration during occurrence

Auto pilot *

Gear *

Flaps *

Flaps position

Slats *

Spoilers *

Weersomstandigheden

Wind direction

Wind speed (kts)

Cloud type

Cloud height (ft)

Precipitation *

Precipitation intensity *

Meteorological conditions *

Visibility (km/m)

Icing

Turbulence *

OAT °C

Runway state *

QNH (hPa)

Windshear *

Light conditions *

Runway type *

Received ATIS

Bird strike

Type of birds

Number of birds seen *

Number of birds struck *

Damage

Damage received

Description

Describe the event in your own words *

What in your opinion caused the event? *

Have you got any further remarks regarding this event?

Reporting an incident: 0800 6353 788