EmailMe Form - ADS-B Grant Scheme Application Form

Date of Application

Application Code

Overall Status

Email Communication

1. I grant consent to CAA for collecting and retaining data in relation to my ADS-B grant application and subsequent claim. *

Yes

Note: The CAA is collecting the information requested in this form for the purpose of assessing and processing ADS-B Grant applications/claims. This data will be retained by CAA for up to 7 years.

2. I confirm that I am the Registered Owner of the aircraft that this application is in relation to; or I have authority to act on behalf of the Registered Owner for this application. *

Yes

Note: For the purpose of this application ‘Ownership’ is that determined by the name under which the aircraft appears on the New Zealand Aircraft Register.

3. I confirm that my aircraft is currently registered on the NZ Civil Aviation Aircraft Register and that it does not have a Maximum Certified Take Off Weight of 7500kg or greater. *

Yes

4. The ADS-B equipment that I intend to install or have already installed meets the requirements of CAA Notice 91.258. *

Yes

5. I understand my aircraft is only eligible for one ADS-B OUT grant and one ADS-B IN grant. *

Yes

6. I understand that ADS-B grants cannot be claimed for installations that occur at the time of aircraft manufacture or prior to its arrival in New Zealand. *

Yes

7. I understand that ADS-B grants cannot be claimed for an ADS-B system that is being installed to replace another older NTC 91.258 compliant version of ADS-B. *

Yes

8. I give consent to CAA to discuss my ADS-B installation with the Avionics Workshop/LAME I have selected on this form. *

Yes

This consent does not include any other matters apart from the installation of my ADS-B system.

9. I understand I must provide evidence to CAA that the installed ADS-B equipment and associated acceptable technical data is suitable, meets the requirements of CAA Notice NTC 91.258, and has been demonstrated to do so. *

Yes

10. I understand that failure to provide acceptable evidence to CAA within twelve months of initial application date will result in my application being rejected and me having to re-apply for an ADS-B grant. *

Yes

Declaration Check

Aircraft registration mark *

Aircraft ID

MCTOW

Aircraft manufacturer *

Aircraft model *

Aircraft serial number *

Aircraft registered owner name *

Aircraft registered owner CAA participant number *

Aircraft Check

Applicant name *

First Last

Applicant’s relationship to registered owner: *

If other please specify

Applicant email address *

Confirm email address

Applicant contact telephone: *

Applicant Check

I am applying for the following ADS-B grant(s) *

Transponder *

If other, please specify *

Manufacturer and Model

Position source *

The transponder and position source equipment lists above are provided as information only. Your selection of a transponder and position source from these lists does not indicate CAA endorsement of that equipment combination. Consult the Acceptable Equipment Lists and discuss your equipment selection with your avionic installer.

If other, please specify *

Manufacturer and model

ADS-B IN *

Manufacturer and model

This aircraft has been booked for its ADS-B installation or has had its ADS-B installed by *

If other, please specify *

Date of installation *

DD / MM / YYYY

Note: Grant applicants cannot apply into the scheme until installation has been booked with a workshop (future applications) or installation has already occurred (retrospective applications).

Future - Date of installation must be within 12 months of grant application date.
Retrospective - Installations from 14 June 2014 are eligible for a retrospective grant.

Retrospective or Prospective

Installation Check

Tech Advisor Email

Lastest possible claim date