危险品航空运输许可申请书

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APPLICATION FOR PERMISSION OF DANGEROUS GOODS TRANSPORT BY AIR

 

1、         综述

 

1.1  运营人法定全名：

Full Legal Name of Operator:                                              

 

1.2  运营人对空运危险品负全部责任的人员姓名：

Name of responsible person for DG Tansportation:               

 

1.3  运营人地址：

Address of applicant:                                         

 

1.4 运营人信息/Informatin of the Operator：

 

(a)电话号码/Telephone:       

 

(b)传真号码/Fax:        

 

(c)运营人三字代码/Operator’s ICAO Designator(3-letter code):         

运营人二字代码/Operator’s IATA Designator(2-letter code):     

 

(d)电子邮箱/Email

                                                            

 

 

(e).负责人通讯地址/Mailing Address

                                                            

 

2、         申请许可的类别/Type of permission for application

□临时许可/Temporary   □定期许可/Long Term

 

3、         申请理由/Reasons of application

□初次申请，正班

Original application, scheduled flight

□初次申请，包机

Original application, Charter Flight

□变更危险品运输地面操作的代理人

Change in agencies of dangerous goods ground handling

□变更危险品运输的种类

Change in category of dangerous goods transported by air

□变更危险品运输的机场

Change in airport of dangerous goods transport by air

□延长许可期限

Permission Extention Application

 

4、         申请运输的危险品类别/Categories of dangerous goods transported by air for application

                                                              

                                                   

                                                  

                                         

                                        

                                        

                                     

                                        

                                     

                                       

 

 

5、         申请实施危险品运输的区域/Conducting area of transport of dangerous goods by air for application

□国内/domestic      □国际/international

 

 

6、         申请实施危险品运输的机场/Airport of transport of dangerous goods for application

 

序号 No.	机场名称 Name of airports	机场代码. Airport Code	机场货物收运/地面操作代理人名称 Name of the contracted third party for ground handling

 

 

7、         包机飞行的飞行计划/Flight Plan for Charter Flight

 

 

8、         运营人的人员训练说明，包括指定的从事与货物操作和运输有关的地面操作代理机构的相关信息，包机需附带机组人员训练证明/Description of training for operator’s employee，including employee of the third party ground handling agents with relation to the handling and transport of cargo，（for charter flight, training certificates of the crews）

 

 

 

 

9、         运营人的危险品手册和危险品训练大纲/Operator’s DG Manual and DG Training Programme

 

 

10、    对于包机，运营人危险品运输文件，至少包括物料安全说明书、危险品申报单、检查单、货单、机长通知单、如适用，包装合格证明。For Charter Flight, Dangerous Goods Documentation，Including MSDS, DGD, Checklist, Airway Bill, NOTOC, and Certification for Packaging, if applicable.

 

 

 

 

11、    应急处置程序。Emergency Response Procedure.

 

 

 

 

12、    CCAR-276的符合性声明。Declaration of Compliance with CCAR-276.

 

 

 

 

13、    确认。Verification.

 

申请人姓名：                      职务：

Name of the applicant                 Title                        

 

申请人签字                              

Signature of applicant                          

签字日期

Date of signature                             

 

注：

1、表格一经填好立即交还当局/The form once completed should be returned to the authority.

2、表格填写不完整可能延迟申请审批/Failure to complete this form in full may result in a delay in processing the application.

3、发放此表并非授权运输危险品/The issuing of this form does not in itself constitute an authorization to carry DG.

4、此表格中“运营人”一词特指问题1.1所示含义/Throughout this form the term "operator" refers specifically to that so identified in question 1.1(Full legal name of the operator).

5、随申请附本提交的文件，如使用的是中文或英文以外的其他文字，应附带准确的中文或英文译本/ All the documentation attached that are not written in Chinese or English should be translated into Chinese or English。

 

 

 

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