Appendix-B
FTC 3/2013
Medical File No : INITIAL CLASS-II
APPLICATION FOR THE ISSUE /ENDT STUDENT PILOT LICENSE ( Aeroplane/ Helicopter/
Glider)
1. Name Drishti Behal
th
(as in 10 certificate)
Father’s Name Capt. Gaurav Behal
Affix self attested
Mother’s Name Vinita Behal recent
2. Date ofthbirth & Age 20/03/2004 photograph of
(as in 10 certificate) size
3. Place of birth Bhopal 3x4
cm
4. Country of birth INDIA
(also enclose
5. Nationality atleast 5
INDIAN photographs with
6. Correspondence Villa 126, The retreat, Tharabanahalli, Chika Jala, 562157, form)
address Bangalore, Karnataka
7. Permanent address Town house A, Central Park 2, Sohan road, Gurgaon
8. Educational Qualification:
Examination Name of Board/ university Year Subjects offered(write name of subjects)
Class X or CBSE 2019 English, French, SST, Maths, Science
(i)
equivalent
10th shall be from recognized Board/ University. For recognition and equivalency please check from Association of Indian Universities.
9. Details of Class-II
Medical Centre Date of medical Valid upto
Karnataka, Bangalore 10-Aug-2021
Class-II medical is valid for one year if age is below 40 yrs and valid for 6 months if age is 40 and above.
10. Fee Details:
Reference Number Place of issue & Bank Name Amount / DATE
0403220007571 BHARATKOSH / INDORE RS:2500 / 4-Mar-2022
Amount of fee is as per Rule 48 {Rs, 3500 i.e. Rs 2500 for SPL (A/H/G) oral examinations and Rs 1000 for issue of SPL}
11. for defense personnel only:
Condition Complied
i) Whether the applicant is/ was in the service of Defense Forces of India. Yes/ No
ii) If serving, No Objection Certificate obtained from the concerned Hqrs. Yes/ No
iv) If not serving, indicate the Force…………………………………………….. N/A
and date of release……………………………………………………
12. Security Clearance:
Date of Security Name of the state police authority Name of the Flying Training Organization
clearance from where Security clearance who forwarded your application for security
is obtained clearance.
Please enclose security copy of the security clearance.
13. Attach the results of the SPL oral examination (in case holding valid pilot license attach self
certified copy of the same)
Declaration by the Applicant
I declare that in terms of provisions of Rule 39A of the Aircraft Rules,1937, I have not suppressed or given
any wrong information herein above for the purpose of obtaining the license/ rating applied for here. I understand
that I am liable for appropriate action, if any information given by me is found to be wrong even at a later date.
Place: INDORE
Date: Signature of the applicant
