APPLICATION TO TENNESSEE BUREAU OF AERONAUTICS FOR AIR CARRIER CERTIFICATE OF CONVENIENCE AND NECESSITY GENERAL INSTRUCTIONS: Submit to Tennessee Bureau of Aeronautics signed original, executed under oath, and six (6) copies of application, including all attachments. Number attachments to conform to the item to which they pertain. Charts and all other attachments should be 8 1/2” x 14” or folded to that size. Enclose check for $25.00 payable to the Bureau as filing fee. ITEM NO.

1. 1. Name of Applicant __________________________________________________________________ Address (general offices) _____________________________________________________________
2. 2. By attachment, identify those served with a notice of the application, including date, place, manner of service and person served. Those served must include any scheduled air carrier or CAB certified carrier which serves or is authorized to serve over the routes proposed to be served by the applicant, or any portion thereof.
3. 3. Applicant is a corporation ______________ Partnership ______________ Individual _____________ Other ______________ Incorporated in the State of ____________________________ on ____________________ (if applicable). Assumed name (if any) will be: ____________________________________________________________

4. 4. If applicant is a corporation, then submit, by use of appropriate attachments, the following:

   1. a. Copies of articles of incorporation with date of incorporation, charter expiration date and name of incorporators shown therein or by attachment, together with amount contributed by each of the incorporators. If an out of state corporation, attach copy of permit from the Secretary of State to do business within the State of Tennessee.
   2. b. Complete information pertaining to authorized capitalization including number of shares of stock of each class authorized and the par value of each share of each class.
   3. c. Amount of any paid-in surplus or earned (or deficit) surplus.
   4. d. Schedule showing number of shares of stock actually issued, to whom issued and, from each stockholder, the cash and/or other consideration received, with description of any other consideration. If any stockholder listed, or any other person has subscribed for additional shares, then the same schedule shall provide all names and in each case the number of additional shares and the amount and nature of the consideration.
   5. e. Names and addresses of all directors and all officers and the amount of stock now held by each as well as any additional shares subscribed for by each.
   6. f. Brief summary of any other businesses in which any director or officer is engaged, with name of the business and nature of the operations.
   7. g. Statement by the applicant that a public offering of its corporate stock has, or has not, been made, and if it has, evidence that the applicant has complied with the laws, rules, regulations of the Federal Securities Exchange Commission and the State of Tennessee.
   8. h. Detailed operating statement and complete balance sheet prepared by a Certified Public Accountant and dated not more than sixty (60) days prior to date application is filed together with a “no substantial change” statement if the financial statements are dated more than thirty (30) days prior to the filing date. If additional liabilities of significance, such as notes given for purchase of aircraft, are anticipated, such information should be submitted as a memorandum. Newly organized corporations may submit pro forma operating statements, so identified.

5. 5. If applicant is an individual or a partnership (or other entity), submit:

   1. a. Name or names, with addresses of the individual or of all the partners (or other entity), together with the names and activities of any other businesses in which said principles are engaged. If a partnership, a schedule showing the amount that each partner has contributed to the air carrier operation; arid, if additional partners are anticipated, their Dames and addresses together with the amount to be contributed by each and the percentage of the partnership that each partner will then own.
   2. b. If applicant has conducted air carrier operations prior to filing for certificate, the following: (1) Profit and loss statement of recent date on which, so far as possible, income and expense items pertaining to air carrier operation are segregated from other income and expense, and (2) Balance sheet or balance sheets of recent date on which, so far as practicable, aircraft and other assets utilized in air carrier operation are segregated from assets utilized for other purposes. Where possible, identify corresponding liabilities.
6. 6. Attach a policy of insurance (or certificate of insurance in lieu thereof) or a surety bond in Dot less than the amounts prescribed in the rules, or submit evidence that application for insurance has been made and that insurance will be issued if an air carrier certificate is granted to applicant. The insurance here referred to pertains to liability covering passengers and other persons, in the air, as well as on the ground, as well as property, and cargo insurance.-Reference Bureau Forms A thru D.
7. 7. Describe proposed air carrier operation by submitting a full description of routes for which authority is sought, identifying all cities, including name of airport, to be served together with a chart depicting proposed routes and also routes of any other scheduled air carrier or CAB certificated carrier which serves or is authorized to serve over the same routes or any portion thereof, Include description of passenger and cargo facilities to be used at each airport.
8. 8. Attach copy of proposed schedules of operation, including times of arrival and departure for each city served, together with frequency of service.
9. 9. Attach a copy of any operating certificate issued by Federal Aviation Administration.
10. 10. Attach complete schedule of fares and rates.
11. 11. Attach Copy of CAB Form 298A, Registration under Part 298 of the Economic Regulations of the Civil Aeronautics Board.
12. 12. Submit evidence to substantiate that the public convenience and necessity will be served by the operation for which authority is requested. Data should be in detail and include present and future need for the service.
13. 13. Submit evidence, including projected operating statements, that the operation will be economically sound. Summarize experience of key personnel in supervision of air carrier flight operations and experience of management in financial and administrative areas of such operations, or in other fields.
14. 14. On attached form describe aircraft that applicant proposes to use and for which authority to operate is requested. Certificated carriers shall not, without prior approval in accordance with rules of the Bureau, operate aircraft other than aircraft so described or other aircraft authorized for the carriers use by the Bureau at the time of certification or subsequent to certification of the carrier.
15. 15. All maintenance will be performed in accordance with Federal Aviation Regulations.
16. 16. Principal operations base will be at (airport & city) _________________________________________ _______________________________________.
17. 17. Does applicant propose instrument flight? _________________________ List equipment in all aircraft equipped for instrument flight _________________________________________________________ ________________________________________________________________.
18. 18. Applicant requests authority to carry: Passengers only _______________Cargo only ______________ Both ______________. The operations proposed in this application, if applicant is granted, will be in accordance with the laws of the State of Tennessee and the United States, the Rules and Regulations of the Tennessee Bureau of Aeronautics and the Federal Aviation Regulations. Date _______________________ Signature of applicant _______________________________________ Title __________________________________________ BEFORE ME, the undersigned authority, a Notary Public in and for said County and State on this day personally appeared _____________________________________ known to me to be the same person whose name is subscribed to the foregoing instrument and declared to me upon oath that the foregoing instrument is true and correct. Given under my hand and seal of office this _______________day of ______________________, 19____ ____________________________________________________________ TBA Form H Revised 5/74 Notary Public in and for _________________________County, Tennessee

Authority: T.C.A. §42-220. Administrative History: Original rule certified June 10, 1974.