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86 AIR REGULATIONS, 1938

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AIR REGULATIONS
APPLICATION FOR PRIVATE AIR PILOT'S CERTIFICATE
(TO BE SUBMITTED IN DUPLICATE)
Name of Applicant
(IN BLOCK CAPITALS, SURNAME PRECEDING)
Permanent Address
(ANY CHANGE IN ADDRESS TO BE NOTIFIED IMMEDIATELY)
Nationality
Date of Birth Place of Birth
CONTROLLER OF CIVIL AVIATION,
DEPARTMENT OF TRANSPORT,
OTTAWA, ONTARIO.
I hereby apply for a certificate authorizing me to act as a Private Air Pilot.  My whole experience in flying has been as follows:--
[[6 columned table]]
| Type | Hours Flown 1st Pilot | Hours Flown 2nd Pilot | Hours Flown Passenger | Area or Route | Year |
|---|---|---|---|---|---|

(The experience claimed above must be verified by duly certified log books or by a certificate from competent authorities.  If space is insufficient, give information on separate sheet.)

* I am a qualified military pilot, having become so while serving with the
* I am not a qualified pilot, but am ready upon notice to undergo the practical tests and examinations required, arrangements having been made for carrying out the practical tests at on a aircraft.
I have received flying instruction at the following Schools or Clubs:-- 
I hereby declare that the above particulars are true in every respect.
I enclose a few of two dollars ($2.00) and three unmounted photographs of myself (not larger than 2" x 3").
(Make cheque payable to the RECEIVER GENERAL.)
Signature of Applicant
Date of Application
* Strike out paragraph inapplicable.
Form 2403