PEDESTRIAN GATE MOBILE PHONE REGISTRATION FORM

APPLICANT DETAILS

Name

Address

Phone

AIRCRAFT CALL-SIGN

TO IDENTIFY YOURSELF OVER THE PHONE, YOU MUST PROVIDE ONE OF THE FOLLOWING:

PLACE AND DATE OF BIRTH

MOTHER’S MAIDEN NAME

PET’S NAME

ACCESS REQUIREMENTS

REASON FOR AIRSIDE ACCESS

(state relevant actions/duties)

ACCESS AREAS

(e.g., hangar no., eastern apron)

IDENTIFICATION REQUIREMENTS

For security reasons, at least ONE of the following identification items must be received in order for your mobile to be registered. (Please provide as much information as possible to expedite processing)

Files attach(Required)

File attach for Photocopy of ASIC card, Photocopy of Pilot’s Licence, Proof of ownership of Aircraft

Drop files here or

Max. file size: 256 MB, Max. files: 3.

ID Number

(5-digit ID number)

Name of club

Proof of employment Hidden

Name:

Position:

Company:

Phone

SIGNATURE

Date

Section Break

Existing Tenant Hidden

Number

Hangar location:

APPLICANT ACKNOWLEDGEMENT AND CERTIFICATION

I acknowledge that in making this application, I undertake that my use of pedestrian gates at Archerfield Airport will be in conformity with the rules and conditions outlined below, which I have read and understand. I certify that the details contained in this application are true and correct. I acknowledge also that Archerfield Airport Corporation (AAC) may cancel or suspend my access given due reason at any time.