Pt. 60, App. C

14 CFR Ch. I (1-1-19 Edition)

Attachment 4 to Appendix C to Part 60-FigmSectione C4B- Sample Letter, Request for Initial, Upgrade, or Reinstatement Evaluation
Attachment: FFS Information Form

INFORMATION
I Date:
..

Settion 1. FSTD Infqrmation and Cltaracteristics

I Sponsor Name:

-

FSTD Location:

Address:

 - 

Physical Address:

City:
State:
Country:
ZIP:
Manager
Sponsor ID No:

 - -

City:
State:
Country:
ZIP:

-

-

(Four Letter FAA Designator)

 - 

 - -11-

 - 

Nearest Airport:
(Airport Desi nator)

..

I0

Type of Evaluation Requested:

0

Aircraft Make/model/series:
Initial Qualification:

 - 

(If Applicable)

IVliVl/UUI

Upgrade Qualification:

Date:

Section(If Applicable)

Date:

Level

Other Technical Information:
FAA FSTD ID No:

0

Continuing Qualification

Manufacturer's
Identification or Serial
Number
UeMQTG

Level

MM/DD/YYYY

Qualification Basis:

Initial 0 Upgrade
Reinstatement

 - 

IDA

lOB

106

107

I

 - 

FSTD Manufacturer:

Convertible FSTD:

UYes:

Date of Manufacture:

Related FAA ID No.

 -  -  - 

Sponsor FSTD ID No:

Special

I

I 0 Interim C
IDe
I 0 Provisional Status

(If Applicable)

0

jOD

....

-MM/DD/YYYY

(If Applicable)

Engine model(s) and data revision:

Source of aerodynamic model:

FMS identification and revision level:

Source of aerodynamic coefficient data:

Visual system manufacturer/model:

Aerodynamic data revision number:

Flight control data revision:

Visual system display:

Mot ion system manufacturer/type:

FSTD computer(s) identification:

National Aviation Authority

fr!~:cable)

NAA FSTD ID No:

Last NAA Evaluation
Date:

 -  - 

NAA Qualification Level:

408

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NAA Qualification Basis: