RPAs Form The agreement form is only a request for approval to operate. Submissions can be declined. RPAS operating unshielded must have a pilot qualification issued by an approved person or organisation or be under direct supervision of a suitably qualified person. Aerodrome(s) Affected* Lake Taupo Aerodrome Taupo Hospital Helipad Centennial Park Aerodrome Heli Adventure Helipad Taupo Airport Turangi Aerodrome Unsure Name of RPAS Operator* First Last Contact Phone Number* Contact Email* Date of Operation* DD slash MM slash YYYY Time of Operation* : Hours Minutes AM PM AM/PM Location of Operation*We are required to knowYou must fully comply with CAA Rule Part 101 or 102Are you the holder of a Part 102 Unmanned Aircraft Operator Certificate?*Reference 102.17 Yes No Have you been granted a variation to Part 101?*Reference 102.21 Yes No Do you understand the rules and requirements of Part 101?*Reference Part 101 Yes No Is your planned operation within 4km of an uncontrolled aerodrome?*Reference Part 101.205 (a) Yes No Will you have an observer in attendance?*Reference 101.205(a)(1)(iii) (A) Yes No Have you been approved by The Director to operate the aircraft above 400ft AGL?*Reference 101.205(a)(1)(iii)(B) Yes No Do you hold a pilot qualification issued by an approved person or organisation?*Reference 101.205(a)(3)(i)(A) Yes No Is your operation a shielded operation?*Reference 101.205(c) Yes No Will you be under direct supervision of a suitably qualified person?*Reference 101.205(a)(3)(i)(B) Yes No Have you sighted and understood the Exclusion Zone applying to RPAS at Centennial Park?*See club website Yes No Not Applicable Are you operating above 200ft AGL?* Yes No Do you have permission from the owner of the property over which you will be flying?* Yes No A NOTAM is required for RPAS operating above 200ftPlease note also that under Rule 101 the operator of an RPA is required to ensure that their aircraft remains in sight at all times, does not fly on or over any active movement area of an aerodrome and gives way to and remains clear of any manned aircraft on the ground or in flight.Terms & Conditions* I acknowledge that I have read, understand and agree to comply with CAA Rules 101 or 102. I understand that any approval given is only applicable to the content I have provided and is not transferable. I also indemnify the Aerodrome I am operating within 4km of, from any liability arising from my actions under the approval. PhoneThis field is for validation purposes and should be left unchanged. Δ
