Form No: CAASL/PL/I/08

CIVIL AVIATION AUTHORITY OF SRI LANKA

APPLICATION FOR CAASL/PL/I/08
INITIAL/AMENDMENT/RENEWAL OF (FORM 19)
IS 66 AIRCRAFT MAINTENANCE LICENSE (AML)

Please complete the form in BLOCK CAPITALS having read the guidance notes attached to this form.
1. APPLICANTS DETAILS: (Do not leave any field blank, otherwise the case will be returned un-actioned)

Full Name : DEWA SAMAN RASIKA JAYARATHNE

Title (Mr. / Mrs. / Ms etc) Mr Date of Birth (dd/mm/yyyy): 10.03.1980

Nationality: SRI LANKAN Place of Birth (City & Country): GALLE

Permanent Address: NO 491/4, 1ST LANE, POLICE QUARTS ROAD, UDAWALAWA

Contact Tel Number: 0761493638 E-mail Address: [email protected]

Address for correspondence

(if different from above):
Change of applicants details : Yes No Please indicate (e.g. change of address)

2. AML DETAILS: (if applicable)

License Number: N/A Date of issue: N/A Date of Expiry: N/A

3. EMPLOYERS DETAILS:

Name of Employer : TRANS MALDIVIAN AIRWAYS Date employment commended: 30.04.2022

Maintenance Organization Address:

approval number:
Email Address: Contact Tel Number:

Previous employer: HELITOURS (PVT) LTD Date of Joining: 23.11.2011 Date of Resignation: 09.01.2022

4. APPLICATION FOR: (tick relevant boxes)

Initial issue of AML Amendment/Change of AML Renewal of AML

i. Additional Category ( see Guidance note 3)
ii. Type Rating Endorsement i. Renewal for 5 years
iii. Name/Address Change
iv. Any other change ii. Renewal for 1 year

Rating: A B1 B2 B3 C

Aeroplane Turbine A1 B1.1 N/A N/A N/A

Aeroplane Piston A2 B1.2 N/A N/A N/A

Helicopter Turbine A3 B 1.3 N/A N/A N/A

Helicopter Piston A4 B1.4 N/A N/A N/A

Avionics N/A N/A N/A N/A

Piston engine non-pressurized aeroplanes of MTOM of 2t & below N/A N/A

Complex motor-powered aircraft N/A N/A N/A N/A

Aircraft other than complex

motor-powered aircraft N/A N/A N/A N/A

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 Form No: CAASL/PL/I/08

Application for Type Rating Endorsements or Limitation removal being requested (if applicable)
Category(s): Type Rating:

5. EXAMINATION MODULES COMPLETED - Please enclose all relevant certificates

CREDIT CLAIM: (not required for AML renewal) (applicable to basic category only)
I wish to claim the following credits (if applicable):
Experience credit for IS 147 approved basic training
(only tick this box if you have attended a IS 147 approved basic training course)
Organization Name:
Course title:
Course completion date: Certificate number:
Experience credit due equivalent examination certificate
(examination credit report will be required)
Name of institute: ELECTRICAL AND INSTRUMENT TRAINING INSTITUTE , INDIA
Credit Report Ref No. FTC/JITT/120/06
Experience credit due to being a skilled worker (Refer IS 66.A.30)
22 YEARS OF EXPERIENCE IN SRI LANKA AIR FORCE

Please enclose all relevant certificates

6a. SUMMARY OF EXPERIENCE: (Not applicable for renewal applications)

Dates Engine(s) Description of work experience

Aircraft Type and/or Details of experience should include the category of such
From To Equipment experience i.e. A, B1, B2 or C

10.03.2003 31.12.2006 B200, Y12 PT6A-42/26 SUPERVISOR B2

13.07.2007 22.11.2011 MI24/35 TB3-117V/VMA SUPERVISOR B2
23.11.2011 09.01.2022 MA60 PW127J SUPERVISOR B2

6b. EXPERIENCE GAINED ON - Applicable to B1.2 and B3 Initial Issues

Aeroplanes with metal tubing covered fabric N/A
Composite structure aeroplanes N/A
Metal structure aeroplanes N/A
Pressurized aeroplanes N/A
Wooden structure aeroplanes N/A

7a. REMOVAL OF LIMITATION FROM BASIC LICENSE:

Limitations to be removed List examination(s) completed

N/A N/A

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 Form No: CAASL/PL/I/08

7b. REMOVAL OF LIMITATIONS FROM TYPE(S) -

List Aircraft Type/Series Engine Limitations to be Removed

N/A N/A

7b. LIST OF ALL RELEVANT CERTIFICATES ENCLOSED WITH THIS APPLICATION:

please attach separate sheet if this space is not enough)
SEE ATTACHED RELEVANT DOCUMENTS

8. DECLARATION OF APPLICANT:
I wish to apply for initial/ amendment/ renewal of IS 66 AML as indicated and confirm that the information contained in
this form was correct at the time of application.
I herewith confirm that:
1. I am not holding any other IS 66 AML issued by DGCA Sri Lanka.
2. I have not applied for any IS 66 AML in CAA Sri Lanka previously and
3. I never had a IS-66 or Part-66 AML issued by DGCA Sri Lanka or in another State which was revoked or
suspended by DGCA Sri Lanka or in any other State.
4. I enclosed the payment slip of the charges payable on application in accordance with the CAASL Fees &
Charges & I agree to pay any additional charges which may become payable in respect of this application under
the CAASL Fees & Charges.
I also understand that any incorrect information could disqualify me from holding a IS 66 AML.

DSR JAYARATHNE
Signature: _____________________________ Name: _________________________________________

/10/2022
Date: ___________________

Note: It is an offence for a person to make, procure to be made, or assist in making any false representations for the purpose of
procuring for any reason the issue, validation, extension or re-issue of a licence, whether for that person or any other person.

9. RECOMMENDATION:

It is hereby certified that the applicant has met the relevant maintenance knowledge and experience requirements of
IS 66 and it is recommended that DGCA Sri Lanka grants or endorses the IS 66 AML.
(Cat C only)
Has been exercising Category B1.1/B1.3/B2 privileges for 3 years as per IS 66.A.30 (a) 3.
Has been exercising Category B1.2/B1.4 privileges for 5 years as per IS 66.A.30 (a) 3.

Name:_______________________________________________________________________________________

Position:______________________________________ Organisations Approval number: ___________________

Signature:____________________________________ Date : ________________________________________

Official Stamp:

NOTE: The referee required to countersign the form must be a Quality Manager or the immediate senior person within the Quality
Department of your current employer, or the organisation where the experience was gained.

10. SUBMISSION INSTRUCTIONS

Documents Submitted:
1. Original IS 66 aircraft maintenance licence (if existing IS 66 licence holder)
2. Certified true copy of your Passport, National Identity Card or Driving Licence (for Initial Issue)
3. Certified true copies of Exam Certificates
4. Certified true copies of Approved IS 147 (or CAA) Certificates of Recognition
5. Certified true copies of Logbook/Work records
6. Certified true copy of Company Authorization for Category 'C' issue.
7. enclose payment slip of the charges payable on application in accordance with the CAASL Fees & Charges
Should the need arise the CAASL retains the right to request the original document if it is deemed necessary in order to
complete the application Please refer to the CAASL Fees & Charges for details of fees required.
Please handover your completed application and supporting documentation as explained in page 5 to:
Director -Training Organization & Personnel Licensing (DTOPEL)
Civil Aviation Authority of Sri Lanka, No 152-1 , Minuwangoda Road, Katunayake, Sri Lanka.
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 Form No: CAASL/PL/I/08

GUIDANCE NOTES, PAYMENT FORM & SUBMISSION INSTRUCTIONS

Guidance Note 1: Introduction

All sections of the application form must be completed by the applicant personally, any section not applicable should be marked
N/A.
Please complete the application form in BLOCK CAPITALS
Having a clear and correctly completed application form, together with any supporting documents (where appropriate) will enable
CAASL to issue licences, ratings and certificates more efficiently, with less risk of errors or rejections and subsequent delays to your
application.
Please note that failure to submit a correctly completed application form, with the required supporting, documents will lead to the
return of your application.

Guidance Note 2: Certifiers of Identification

The following people can act as 'certifiers':
 Head of a IS 145/147 Organisation.
 CAASL Inspector designated by Director -Training Organization & Personnel Licensing (DTOPEL)
Instructions for the certifier of your ID document are as follows:
1. Insert on the copy to be enclosed with the application: 'I have seen the original document and I certify that this is a
complete and accurate copy of the original'.
2. Insert signature and date.
3. Certifier’s name must be printed/written in block capitals.
4. Must include position or capacity, e.g. Head of a IS 145/147 Organisation.

Guidance Note 3: Sections of the Form Explained

Section(s) 1, and 2 Personal/ Details
To be completed in all cases
Section 3 - Employer Details
Please enter details of your current employer, including the organisations Approval Number.
Section 4 - Application
Renewal of AML- have two options (5 years or One year) for Renewal of AML. Therefore please Indicate the licence validity
period if you wish to apply. Please note that if the licence is already expired, option shall be “one year”.
Indicates what type of licence you are applying for. For type rating(s) endorsement, please list the individual types by
airframe/engine combination.
Section 5 - Examination Modules Completed
1) To be completed if claiming a reduction in the experience requirements on the basis of completing an Approved IS 147 Basic
Training Course or
2) Claiming an exam accredited and recognized by the CAASL.
3) please enter Details of Examination modules completed at CAASL examination pertaining to the category requested
Section 6-7 - Essential Information
Completing the relevant sections will enable your application to be processed more efficiently, failure to supply this information
may result in your application being delayed while we endeavor to contact you.
Section 6a – Summary of Aircraft Maintenance Experience
Enter a summary of any experience that is relevant to the application in this section. This section must be completed. Other
documents may be used but they must be referenced here. Certified true copies of original experience documents must be
submitted, (the nominated signatory must state that they certify document is a complete and true copy of original along and
insert their name (in block letters),signature, date and job title), this experience needs to be certified by Quality Manager or
accepted nominated signatories. Required maintenance experience shall be written up in a manner that the reader has a
reasonable understanding of where, when and what maintenance constitutes the experience. Cross referencing experience to
logbooks/work records submitted is unacceptable, a brief summary of experience relevant to the application will be required.
Section 7b- List of all relevant certificates enclosed with this application
Original Certificates of Recognition must be supplied. Certified true copies of originals may be accepted if the copy is verified
as per above Guidance Note 2.
Section 8 - Declaration
This section is to be completed in all cases
By signing the declaration you are confirming that all of the information is correct and true.
Section 9 – Recommendation(not for Part-66 renewal)
The referee required to countersign the form must be a Quality Manager or the immediate senior person within the Quality
Department of your current employer, or the organization where the experience was gained.

Guidance Note 2: Documents, Fees and Submission Instructions

This section should be used to ensure that the appropriate documents relevant to the application are submitted
This application will not be processed until the applicable charges have been received

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 Form No: CAASL/PL/I/08

Required information / Documents that shall be submitted with each IS 66 AML Application

Initial Issue Amendment

Additional Category / Sub-Category
 CAASL Form 19 (this form) properly completed and  CAASL Form 19 (this form) properly completed
signed. and signed.
 Copy of Passport or National Identity Card  Copy of Passport or National Identity Card
 Copy of Birth Certificate  IS 66 AML (Original, not a Copy)
 02 coloured stamp size photographs (2cm x 2.5 cm)  02 coloured stamp size photographs (2cm x 2.5
 Copy of Knowledge examination results issued by cm)
CAASL for the required category(s).  All relevant IS 66 modular certificates for the
 Course completion certificate (Certificates of required category(s). See guidance note for
Recognition) issued by Training Organization for the section 7b.
required category(s). See guidance note for section 7b  Knowledge examination results issued by CAASL
 Evidence of the required experience, including for the required category(s).
appendix 1. See guidance note for section 6a.  Evidence of the required experience, including
 Payment Slip. appendix 1. See guidance note for section 6a.
 Completed payment slip.

Amendment Amendment
Addition of Type Rating Removal of a limitation

 CAASL Form 19 (this form) properly completed and  CAASL Form 19 (this form) properly completed
signed. and signed.
 Copy of Passport or National Identity Card  Copy of Passport or National Identity Card
 IS 66 AML (Original, not a Copy)  IS 66 AML (Original, not a Copy)
 02 coloured stamp size photographs (2cm x 2.5 cm)  02 coloured stamp size photographs (2cm x 2.5
 Type training certificate(s) which must cover cm)
theoretical training & Examination and practical  All relevant IS 66 modular certificates for the
training & assessment. required category(s). See guidance note for
 Completed on the Job Training (for first type rating section 7b.
only). This should be performed at a CAASL approved  Evidence of the required experience, including
IS 145 organization. If not, the OJT must be accepted appendix 1. See guidance note for section 6a.
by the CAASL prior to use  Completed payment slip.
 Completed payment slip.

Renewal Duplicate Issuance

 CAASL Form 19 (this form) properly completed and  CAASL Form 19 (this form) properly completed
signed. and signed.
 IS 66 AML (Original, not a Copy)  Police report.
 02 coloured stamp size photographs (2cm x 2.5 cm)  Requested letter sign by holder.
 Completed payment slip.  02 coloured stamp size photographs (2cm x 2.5
cm)
 Completed payment slip.

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 CIVIL AVIATION AUTHORITY OF SRI LANKA
APPLICATION FOR INITIAL/AMENDMENT/RENEWAL OF IS 66 AIRCRAFT CAASL/PL/I/08 (FORM 19)
MAINTENANCE LICENSE (AML)

Appendix 1: Basic Experience Matrix (see Guidance Notes)

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