A certified report to demonstrate adequate competence in aviation medicine and
substantiating the experience and training shown on the Application Form.
A properly completed prescribed Application Form.
A statement affirming that there are no current restrictions of medical
practice, and there are no adverse actions proposed or pending that would
limit medical practice by the licensing board, the Drug Enforcement
Administration, any medical society, any hospital staff, or by any other
organization that may have licensing or certification authority.