APPENDIX 3
Incident Reporting Form
Incident Reporting
AutoGyro Form AG-F-AIR-V2.A
Use this form to register as (new) operator / owner, in order to receive safety and service related
information concerning your aircraft. The information is stored in a database and is only used within
AutoGyro GmbH for the above purpose.
Without proper and timely registration, the operator will not receive vital information, which may lead
to unsafe flight or an un-airworthy aircraft.
Return this form to:
AutoGyro GmbH
Dornierstraße 14
31137 Hildesheim or E-Mail to [email protected]
Aircraft Type:
Serial Number (Werk-Nr.):
Registered at:
(Airworthiness authority)
Registration / Call Sign:
curr./new:
previous:
Year of manufacture:
Engine Type:
Airframe S/N:
Rotor System S/N:
Engine S/N:
Airframe hours:
Rotor System hours:
Engine hours:
Previous Owner (if applicable) - please state name, full address, phone and E-Mail
Signature and Date
New/current Owner - please state name, full address, phone and E-Mail
Signature and Date
Below fields are used for AutoGyro internal processing – do not fill in!
Data entered onto database
(by / when)
Acknowledgement sent (date)
(by / when)
