May 2011
V.
SI 47-01 Amdt. 1
CATATANPENJAMINAN (MORTGAGE RECORDJ
(Pencatatan penjaminan ini dilakukan berdasarkan permintaan daninformasi yang diberikan oleh pemohon terhadap adanya suatu penjaminan, dilengkapi dengan akta Hipotek danakta Perjanjian Pinjaman dansural keterangan tentang penjaminan dari para pihak yangterlibat)
(Record ofMortgage ismade according lothe request and information submitted by applicant along w/tfi Mwtoage Deed and Loan Agreement and aknowledgement letter from eachpady) Nama dan Alamat Penerima Jaminan:
Name and Addiess ct Afortgagee
Inspektur
Nomor sural pencalatan penjaminan:
Tanggal:
Raterenced tellerol mortgagerecord
Dale
VI.
Inspector
PENGHAPUSAN PENJAMINAN (RELEASE ofMORTGAGE)
Nomorsurat penghapusan pencatatanpenjaminan:
Tanggal:
Referenced letter ol cancellation ofniolgage tecord
Date
VII.
Inspektur Inspector
CATATAN IDERA (IDERA RECORD)
Nama Debitur:
Alamal (Address)
Oeofor Name
NamaPihak yangdiberi Kuasaatau Orang yangDitunjuk secara San":
Alamal(Address):
Authorized Pailyof Certified Designee'
Referensi Perjanjian: Agreement made as Releience
Tanggal Persetujuan dan Pencatatan DAAO Form47-03
Inspektur
Date AgreedandLodaed ol DAAO Form47-03
Inspector
VIII.
PEMBATALAN IDERA (REVOCATION ol IDERA)
Nomorsural pembatalan IDERA:
Tanggal:
Referenced letter of revocation of IDERA
Dale
IX.
Inspektur Inspector
PENGHAPUSAN TANDA PENDAFTARAN PESAWAT UDARA (CANCELLATION OF REGISTRATION)
Nomor PersetujuanPenghapusan Tanda Pendaftaran:
Tanggal:
Cancellation Registration Approval Number
Dale
Nomor Pemberitahuan PenghapusanTanda Pendallaran:
Tanggal:
Confirmation Cancellation Registration Number Tanggal Penghapusan Tanda Pendaftaran
Dale
Cancellation Registration Dale
AlasanPenghapusan:
Inspektur
Reason tor Cancellation
Catalan (note)
inspector
' Coret yang tidak periu (Cross as required) " Pilih yangiSSuai | fie* cc; e»ae eat)
A. BAGIAN II(Secr.on II)
PERPANJANGAN SERTIFIKAT PENDAFTARAN PESAWAT UDARA
(RENEWAL of CERTIFICATE OF REGISTRATION) Tanggal
[Date}
Berlaku Sampai Dengan (Validity)
Nama Inspektur (Inspector Nme)
Tanda Tangan (Signature)
Keterangan (Remarks)
I
DAAO Form 47-2B (04/11)
APPENDIX 5
APP 5-2
May 2011
SI 47-01 Amdt. 1
BAGIANII(Secfionlf)
Lembar Lanjutan (continuationpage) : ' ->:.• PERPANJANGAN SERTIFIKAT PENDAFTARAN PESAWAT UDARA
(RENEWAL ofCERTIFICA TE OF REGISTRA TION) Tanggal (Date)
\
Berlaku Sampai Dengan (Validity)
Nama Inspeklur (InspectorName)
Tanda Tangan (Signature)
Keterangan (Remark)
.
i
DAAO Form 47-2B (04/11)
APPENDIX 5
APP 5-3
May 2011
SI 47-01 Amdt. 1
Appendix 7 - Application for Cancellation of Aircraft Registration, DAAO Form 47-17
KEMENTERIAN PERHUBUNGAN MINISTRY OF TRANSPORTATION
ta«&
DIREKTORAT JENDERAL PERHUBUNGAN UDARA DIRECTORATE GENERAL OF CIVIL AVIATION
DIREKTORAT KELAIKAN UDARA DAN PENGOPERASIAN PESAWAT UDARA DIRECTORATE OF AIRWORTHINESSAND AIRCRAFT OPERATIONS PERMOHONAN PENGHAPUSAN TANDA PENDAFTARAN PESAWAT UDARA
Application for Cancellation of Aircraft Registration Tanda Pendaftaran
Nomor Pendaftaran
Tipe Pesawat Udara
Nomor Seri
Registation Mark
Registration Number
Aircraft Type
Serial Number
Nama Operator Name of Operator Nama & Alamat Pemilik Nam & Address of Owner
Alasan Penghapusan"
Selesai Perjanjian Sewa Guna
Reason for Cancellation
Usaha
Intended tobe register to another
Expiration of lease agreement
country
Akan didaftar di negara lain
Penghentian perjanjian yang
Tidak digunakan secara
disepakati para pihak Terminating agreement as agreed upon each party
permanen Withdrawn from use
Rusak total akibat kecelakaan Total loss during accident
Sengaja dimsak
Pergantian kepemilikan
Intentionally destroyed
i
Chance of Ownership
Melampirkan referensi : perjanjian'bukti kepemilikan.'keterargan rusak* Attached reference: agreement/evidence ofownership /evidence ofreturn tocustody Keterangan catatan penjaminan di DKUPPU** Record of Mortgage filed with DAAO
Ada
Tidak Ada
Yes
No
Nomor Surat Penjaminan DKUPPU: DAAO referenced letter
Melampirkan bukti selesai penjaminan (apabila ada) / pemyataan tidak dijaminkan (apabila tidak ada)*
Attached settlement ofmortgage (for a recorded mortgage) / statement ofno mortgage (for no recorded mortgage) Melampirkan surat kuasa (apabila permohonan dilakukan oleh selain operator atau pemilik)
Attached Power ofAttorney (for application made byother than operator or owner) Tanggal Efektif Penghapusan Effective Cancellation Date
Dibuat Rangkap 2 Made In2 copies
Coret yang tidak diperlukan Cross as necessary
Beri tanda X pada kotak yang terkait
Tempat: Place
Tanggal: date
TickApplicable Box
Nama: Name
Meterai dan
Tanda Tangan
Cap Perusahaan Signature
Jabatan: Title
DAAO Form 47-17 (04/11)
APPENDIX 7
APP 7-1
May 2011
SI 47-01 Amdt. 1
Appendix 6 - Application for Renewal of Certificate of Registration, DAAO Form 47-13
KEMENTERIAN PERHUBUNGAN MINISTRY OF TRANSPORTATION
DIREKTORAT JENDERAL PERHUBUNGAN UDARA DIRECTORA TE GENERAL OF CIVIL A VIATION
DIREKTORAT KELAIKAN UDARA DAN PENGOPERASIAN PESAWAT UDARA DIRECTORA TE OF AIRWORTHINESS AND AIRCRAFT OPERATIONS PERMOHONAN PERPANJANGAN SERTIFIKAT PENDAFTARAN APPLICATION FOR RENEWAL OF CERTIFICATE OF REGISTRATION
A. 01.
DATA PESAWAT UDARA /AIRCRAFT DATA Tanda Pendaftaran Pesawat Udara:
02. Nomor Pendaftaran Pesawat udara:
Aircraft Registration Marking 03.
AircraftRegistration Number
Masa berlaku Sertifikat Pendaftaran:
04.
Validity of Cof R
Masa berlaku Sertifikat Kelaikudaraan:
Validity of Cof A
05. Nomordan Masa berlakuAsuransi Pesawat Udara (lampirkan) Number and Validityof Insurance (attach)
B.
DATA OPERATOR PESAWATUDARA/ AIRCRAFT OPERATOR DATA 07. Alamat Operator:
06
Nama Operator: Operator's name
C
DATA KEPEMILIKAN / OWNERSHIP DATA Bukti Kepemilikan:
08
Operator's Address
09. Tanggal :
Evidence of Ownership 10,
Dote
Pemilik:
11. Alamat:
Owner
P. 12
Address
DASAR PENGUASAAN / TERM OFPOSSESSION' Referensi:
Sewa Guna Usaha
Pembelian Bersyarat
Lain-lain (tuliskan):
Reference
Lecsing
Conditional Sole
Other (specify)
13. Perjanjian Sewa Guna Usaha (tanggal dan masa sewa): Lease Agreement (date and leasing periods) 14.
Perjanjian Pengikatan Hak Bersyarat (tanggal; Title Reservation Agreement (date)
I 15. Nama Penyewa Baru (Lessor) / Penjual Bersyarat
•~d~re ss
17. Marr.a Pemberi Sewa (lessee) / Pemoeli Bersvarat (ConditionalBuyer) / Lainnya (other)': E.
Alamat:
16.
(ConditionalSeller) / Lainnya (orrier)":
Aiara::
Address
ALASAN PERPANJANGAN C OF R / REASON FORRENEWAL*
19.
Habis Masa Berlaku C of R
Expiration of Cof R
Perubahan Pemilik/Pemberi sewa
Hilang/Rusak*
Changes of Ownership/Lessor
Lost / destroyed
20. LampirkanReferensi C cf R/ BuktiKspemifikan / Pi
Keterangan k'ehilar.gan (atau Kerusakan)* . cgna of lost (c cestroyed.
Attachreferencefor c of R/ Evidence afOwnersh p ,;-
Dalam halalasan perpanjangan adalah perubahan pen-,.k atau pe-rcerisewa, maka bagian Cdan Ddiisidata baru In thecase reason for renewal is changeof ownerorlessor, fill in column CandDwith thenew data F, 20.
LAIN-LAIN / OTHERS " Kepabeanan
Impor Telap
2r Sen-er'a^a
Customs Clearance
Permanent Import
pc-ary .r-pzr.
Catatan : Note
Coret yang tidak perlu Cross as necessary
Pilih kotak yang sesuai Tick applicable box
Lainnya (sebutkan) Other (specify)
Dibuat dengan sesungguhnya: / certify chat clt information are true and correct Tempat: Place
Tanggal: Date
Nama Name
Melerai
dan Cap Perusahaan
Tanda Tangan Signature
Jabatan: Title
DAAO Form 47-13 (04/11)
APPENDIX 6
APP 6-1
MaV2011
SI 47-01 Amdt. 1
Appendix 8 - Checklist Cancellation of Registration, DAAO Form 47-17 KEMENTRIAN PERHUBUNGAN
DIREKTORAT JENDERAL PERHUBUNGAN UDARA DIREKTORAT KELAIKAN UDARA DAN PENGOPERASIAN PESAWAT UDARA JL. ME DAN MERDEKA BARAT NO. 8, JAKARTA PUSAT 10110 INDONESIA TEL. : (62-21) 350.6664,350.6665 FAX.: (62-21) 350.6663
•• -:>•:•-•••:•
^s^^-v^'r^i^,-,--
P.O.BOX 3049, JAKARTA 10030. INDONESIA CHECKLIST -
CANCELLATION OF REGISTRATION
AircratType : Serial Number :
Registration Mark Registration Number
:
1. Application of Deregistration, DAAO Form 47-17* (check one applicable box) ~\ a. Requested by Operator Name •
•
b.
Requested by Lessor
I
Ic.
Requested by Owner
'
'
Mama Name :•
Mamo Name •
| |d- Requested by authorised person* or certified designee* using IDERA (cross as applicable) certificate ofdesignation (asapplicable), please specify : Form of IDERA, DAAO Form 47-03, dated :
2. Application issigned by 'company authorised' person. Evidence :
3. Acknowledgement/Consent Letter to the Deregistration from parties other than applicant (not applicable when it is requested using IDERA' (check any applicaale box)
I [a. Operator
Name & Address :
~lb.
I
Lessor Name & Address :
|c. Sub Lessor
Name & Address : id.
Owner
Name & Address :
3. Power of Attorney (or other delegation form) when coresspondance made by attorney's of applicant • Name of Attorney in Fact:
|
4- Reason of Cencellation* (check oneapplicable bet) |a. Termination of Lease Agreement
|
|b- Default of contract (non performance) by lessee or debtor (IDERA)
|
|c- Transfer ofownership dated : 20 November 2010
^d. Total loss of aircraft during accident Js. Permanently withdrawn from use of aircraft I |f- Intentionally scrapped or destroyed of aircraft
I |g. Intended to be registered into other country
I |h. Airworthiness can not be maintained for more than 3years continuously (when this condition occured, complete item 6, 7, 9, 10 only)
5. When item 4.d. ticked (total loss on accident), attached evidence of return to custody form KNKT Reference :
DAAO Form 47-17A (04/1'
APPENDIX 8
Page 1 of 2
APP 8-1
May 2011
SI 47-01 Amdt. 1
6. Cancellation ofMortgage Record (for recorded mortgage) a.
Name of Mortgagor :
b. Name of Mortgagee: c.
Date of Cancellation :
7. Statement of 'No liens against the aircraft or the aircraft is not under mortgage nor any liensf form operator or owner.
8.
Deregistration Permit from Director General :
9.
Deregistration Letter number:
10. Issue 'Notification Letter' to importing country (check address of registration office) 11. Entry information ofderegistration on DAAO Form 47-2B Kartu Pendaftaran 12. Entry data on Deregistration Log Book
Data required for 'aircraft deregistration' has been checked and found :
•
SATISFACTORY
•UNSATISFACTORY
to meet the requirements.
J Letter or e-mail' (cross one) regarding the required data has been delivered (applicable for UNSATISFACTORY condition, as an interim process).
I
I Deregistration statement is recommended to be issued.
| | Data returned to PM (when deregistration statement has been issued) for filing.
L J Name of Inspector NOTE:
This check list (when fully completed) will substantiate as a report toKasubdit and Kasi
Correspondance letter or e-mail can be used as an evidence of processing the task Data (other than original form) is strongly recommenced nelectronic oopy
DAAO Form 47-17A (04/11)
APPENDIX 8
Page 2 of2
APP 8-2
