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64a Interagency Form

64a Interagency Form

Use a legal form 64a template to make your document workflow more streamlined.

Seaplane PIC Make & Model PIC Make & Model PIC Make & Model IFR Simulated IFR Actual PIC Night PIC Large Airplane (>12,500#) PIC Turboprop PIC Jet PIC Low Level Airplane (<500’ AGL) PIC Airtanker/Dispensing Ops. PIC Mission Specific PIC Typical Terrain Hours h. Date of Last Agency Flight Evaluation Date of Previous Agency Card □YES □NO □YES □NO □YES □NO PILOT HISTORY: __________________ __________________ (Attach a copy) □OAS □USFS □OAS □USFS Aircraft accidents within the last 5...
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