Air Transportation Regulations

(Name and address of licensee)(Date)

TO :

The Secretary

Canadian Transportation Agency

Ottawa, Ontario

Canada K1A 0N9

(Name of licensee), holder of Licence  No (number of licence) issued on (date of issuance  of licence), hereby declares that  (name of licensee) continues  to have the qualifications necessary  for the issuance of  the said licence, namely, that the licensee

• (a) is

  • (i) a Canadian or exempt from this requirement under section 62 of the Canada Transportation Act,

  • (ii) pursuant to subsection 69(2) or (3) of that Act, eligible to hold a scheduled international licence, or

  • (iii) a non-Canadian and holder of a  document issued by the government of the licensee’s state or  an agent thereof that,  in respect  of the  service provided under  the document,  is equivalent  to the  non-scheduled international licence;

• (b) holds a valid Canadian aviation document in respect of the service provided under the licence; and

• (c) has liability insurance coverage in accordance with section 7 of  the Air Transportation Regulations in respect of the service provided under the licence.

(signature, name and title of authorized officer)

Corporate seal (if a Corporation)