APPROVAL FORM

FOR

**[OPERATION OF STATE-OWNED AIRCRAFT NOT RVSM APPROVED]{.underline}**

# TO: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

FROM:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

PHONE NUMBER:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

FAX NUMBER:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

+-----------------------------------------------------------------------+
| ## [OPERATION OF STATE-OWNED AIRCRAFT NOT RVSM APPROVED]{.underline}  |
|                                                                       |
| ##                                                                    |
|                                                                       |
| ##  ACFT CALL SIGN: \_\                                               |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| **TYPE AIRCRAFT:                                                      |
| \_\_\                                                                 |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                                                       |
| **DEPARTURE AIRPORT:                                                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**      |
|                                                                       |
| **OCEANIC ENTRY FIX:                                                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**    |
|                                                                       |
| FIX NAME or LAT/LONG                                                  |
|                                                                       |
| **DATE/TIME:                                                          |
| \_\_\_\_\_\_\_\_\                                                     |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                                                       |
| UTC                                                                   |
|                                                                       |
| **REQUESTED OCEANIC ALTITUDE:                                         |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**                            |
|                                                                       |
| **ROUTE:                                                              |
| \_\_\_\_\_\_\_\_\_\_\_\                                               |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                                                       |
| **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                           |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                                                       |
| **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                           |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                                                       |
| **OCEANIC EXIT FIX:                                                   |
| \                                                                     |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                                                       |
| FIX NAME or LAT/LONG                                                  |
+-----------------------------------------------------------------------+

OPERATORS OF STATE AIRCRAFT (MILITARY, CUSTOMS OR POLICE SERVICES) MAY
FLIGHT PLAN IN DESIGNATED RVSM AIRSPACE IN ACCORDANCE WITH INSTRUCTIONS
PUBLISHED IN APPROPRIATE STATE FLIGHT INFORMATION PUBLICATIONS.

THIS FORM IS DESIGNED TO ASSIST THE AIRCREW IN THE ADVANCE NOTIFICATION
PROCEDURES FOR THE UNITED STATES AND JAPAN. COMPLETE THIS FORM IN ITS
ENTIRETY AND FAX IT TO THE APPROPRIATE FLIGHT INFORMATION REGION OR
CENTER NOT MORE THAN 72 HOURS AND NOT LESS THAN 4 HOURS PRIOR TO THE
INTENDED DEPARTURE TIME

NO FURTHER COORDINATION IS REQUIRED FOR ANCHORAGE OR OAKLAND CENTERS
UNLESS REQUESTED BY THE CENTER.

[ANCHORAGE AIR ROUTE TRAFFIC CONTROL CENTER]{.underline}

TELEPHONE: 907-269-1108

AFTN: PAZAZQZX

**FAX: 907-269-1343** *(IF FAX'D BETWEEN THE HOURS 0200Z -- 1400Z PLEASE
CALL TO CONFIRM RECEIPT)*

OAKLAND AIR ROUTE TRAFFIC CONTROL CENTER

TELEPHONE: 510-745-3320 or 510-745-3342

AFTN: KZOAZRZX

**FAX: 510-745-3411**

THIS FORM **[DOES NOT]{.underline}** ELIMINATE THE REQUIREMENTS FOR A
VERBAL COORDINATION WITH TOKYO OR NAHA ACC TO COMPLETE THE NOTIFICATION
REQUIREMENT.

TOKYO AIR CONTROL CENTER -- TOKYO, JAPAN

TELEPHONE: 81-42-992-1334

AFTN: RJTGZQZX

**FAX: 81-42-994-0942**

# NAHA AIR CONTROL CENTER -- NAHA, OKINAWA, JAPAN

# TELEPHONE: 81-98-858-8206

AFTN: RORGZQZX

### FAX: 81-98-858-7427