GenDec - Madinina Pilot Club

GENERAL DECLARATION
GENERAL DECLARATION
(OUTWARD / INWARD)
OPERATOR :
(Exploitant)
Madinina Pilot Club
DATE :
(mm/dd/yy)
/
/
(OUTWARD / INWARD)
MARKS OF NATIONALITY AND REGISTRATION :
(Signes de nationalité et immatriculation)
OPERATOR :
(Exploitant)
TYPE OF AIRCRAFT :
(Type d’appareil)
DATE :
(mm/dd/yy)
Madinina Pilot Club
/
/
MARKS OF NATIONALITY AND REGISTRATION :
(Signes de nationalité et immatriculation)
TYPE OF AIRCRAFT :
(Type d’appareil)
DEPARTURE FROM :
(Départ de)
ARRIVAL AT :
(Arrivée à)
DEPARTURE FROM :
(Départ de)
ARRIVAL AT :
(Arrivée à)
DEPARTURE TIME :
(Heure de départ)
ARRIVAL TIME :
(Heure d’arrivée)
DEPARTURE TIME :
(Heure de départ)
ARRIVAL TIME :
(Heure d’arrivée)
CREW MANIFEST
(Liste équipage)
FUNCTION
NATIONALITY
(Fonction)
(Nationalité)
NAME
(Nom)
LICENCE #
(N° Licence)
CREW MANIFEST
(Liste équipage)
FUNCTION
NATIONALITY
(Fonction)
(Nationalité)
NAME
(Nom)
PILOT
LICENCE #
(N° Licence)
PILOT
CO-PILOT
CO-PILOT
PASSENGER MANIFEST
(Liste passagers)
PASSENGER MANIFEST
(Liste passagers)
LAST NAME / INITIAL (Nom / Prénom)
NATIONALITY (Nationalité)
1
2
3
4
5
6
LAST NAME / INITIAL (Nom / Prénom)
NATIONALITY (Nationalité)
1
2
3
4
5
6
AIRWAY BILL #
DECLARATION OF HEALTH
# OF PACKAGES
(Nbre de colis)
CARGO MANIFEST
(Manifeste Cargo)
NATURE OF GOODS
(Nature de la marchandise)
Persons on board with illnesses other than airsickness or the effects of
accidents (including persons with symptoms or signs of illness such as rash,
fever, chills, diarrhoea) as well as those cases of illness disembarked during
the flight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.......................................................
Any other conditions on board which may lead to the spread of disease . . . .
.......................................................
.......................................................
Details of each disinsecting or sanitary treatment (place, date, time, method)
during the flight. If no disinsecting has been carried out during the flight,
give details of most recent disinsecting . . . . . . . . . . . . . . . . . . . . . . . . . . .
.......................................................
Animals, birds, insects, bacterial cultures or viruses on board : . . . . . . . . . .
.......................................................
Plants, unprocessed animal and plant products or fungus culture on board
(when required by States on arrival) : . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GROSS WEIGHT
(Poids total)
FOR OFFICIAL USE ONLY
SPRAYED ON :
(Date)
AIRWAY BILL #
DECLARATION OF HEALTH
# OF PACKAGES
(Nbre de colis)
CARGO MANIFEST
(Manifeste Cargo)
NATURE OF GOODS
(Nature de la marchandise)
Persons on board with illnesses other than airsickness or the effects of
accidents (including persons with symptoms or signs of illness such as rash,
fever, chills, diarrhoea) as well as those cases of illness disembarked during
the flight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.......................................................
Any other conditions on board which may lead to the spread of disease . . . .
.......................................................
.......................................................
Details of each disinsecting or sanitary treatment (place, date, time, method)
during the flight. If no disinsecting has been carried out during the flight,
give details of most recent disinsecting . . . . . . . . . . . . . . . . . . . . . . . . . . .
.......................................................
Animals, birds, insects, bacterial cultures or viruses on board : . . . . . . . . . .
.......................................................
Plants, unprocessed animal and plant products or fungus culture on board
(when required by States on arrival) : . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GROSS WEIGHT
(Poids total)
FOR OFFICIAL USE ONLY
SPRAYED ON :
(Date)
I declare that all statements and particulars contained in this General Declaration, and in any supplementary forms required to be
presented with this General Declaration, are complete, exact and true to the best of my knowledge.
Je déclare que cette Déclaration Générale et ses annexes éventuelles sont renseignées et complétées en fonction de tous les éléments
et informations en ma connaissance.
I declare that all statements and particulars contained in this General Declaration, and in any supplementary forms required to be
presented with this General Declaration, are complete, exact and true to the best of my knowledge.
Je déclare que cette Déclaration Générale et ses annexes éventuelles sont renseignées et complétées en fonction de tous les éléments
et informations en ma connaissance.
SIGNATURE _________________________
SIGNATURE _________________________
Authorized Agent or Pilot-in-command
Authorized Agent or Pilot-in-command