Federal Aviation Administration, DOT

Pt. 60, App. D

Attachment 4 to Appendix D to Part 60 -  - -Figure D4B- Sample Letter, Request for Initial, Upgrade, or Reinstatement Evaluation
Attachment: FSTD Information Form
INFORMATION
Date:

Section 1. FSTD ~  - :.u ..... u.... and Characteristics
FSTD Location:

Sponsor Name:

 - 

Address:
City:

I

Pb)":"' Add"'"

 - 

1-

1-

State:
Country:
ZIP:
Manager

Country:
ZIP:

1-

Sponsor ID No:

I (four Letter FAA Designator)

 - 

Nearest Airport:

I (Airport Designator)

I0

Type of Evaluation Requested:
Aircraft Make/model/series:
Initial Qualification:
(If Applicable)

0

Initial 0 UpgtSectionade
Reinstatement

-

Date: _Level

...

Continuing Qualification

0

Special

Manufacturer's
Identification or Serial
Number
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MlVI/lJU/

Date: ~Levl
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Upgrade Qualification:
(If Applicable)
Qualification Basis:

0

 - 

IDA
ID6

I0
ID

!DB
ID7

Interim C

!De

Provisional Status

T

.

IDD

.

......

:Section .

Other Technical Information:
FAA FSTD ID No:
(If Applicable)
Convertible FSTD:

 - 

FSTD Manufacturer:

DYes:

Date of Manufacture:

Related FAA 1D No.

 -  -  - 

Sponsor FSTD ID No:

-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
.

~icable)
NAA FSTD ID No:

Last NAA Evaluation
Date:

NAA Qualification Level:
NAA Qualification Basis:

 -  - 

 - 

I

Motion System Manufacturer
and Type:

FSTDS. - 

Available:

1

479

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Visual System Manufacturer
and Type: