Appendix B to Part 208 - Statement of Supporting Information

Part I—To be completed by air carrier for each single entity, mixed, or pro rata charter. (Where more than one round-trip flight is to be performed under the charter, clearly indicate applicability of answers.)

1. Name of transporting carrier:

2. Commencement date(s) of proposed flight(s):

(a) Going

(b) Returning

3. Points to be included in proposed flight(s):

(a) From

to

(b) Returning from

to

(c) Other stops required by charterer:

4. (a) Type of aircraft to be used:

(b) Seating capacity:

(c) Number of persons to be transported:

5. Total charter price:

6. (a) Has the carrier paid, or does it contemplate payment of any commissions, direct or indirect, in connection with the proposed flight? Yes [] No []

(b) If “yes” give names and addresses of such recipients and indicate the amount paid or payable to each recipient. If any commission to a travel agent exceeds 5 percent of the total charter price, attach a statement justifying the higher amount under this regulation.

7. (a) Will the carrier or any affiliate provide any services or perform any functions in addition to the actual air transportation? Yes [] No []

(b) If “Yes” describe services or functions:

8. Name and address of charterer:

9. If charter is single entity, indicate purpose of flight:

10. On what date was the charter contract executed?

11. If the charter is pro rata, has a copy of part 208 of the Civil Aeronautics Board's economic regulations been mailed to or delivered to the prospective charterer?

Yes [] No [] Part II—To be completed for pro rata or mixed charters only. Sections A—To be supplied by travel agent, or where none, by the air carrier or an affiliate under its control where either of the latter performs or provides any travel agency function or service (excluding air transportation sales but including land tour arrangements).

1. What specific services have been or will be provided by agent to charterer on a group basis?

2. What specific services have been or will be provided by agent to individual participants in the proposed charter?

3. Has the agent or, to his knowledge, have any of his principals, officers, directors, associates or employees compensated any member of the chartering organization in relation either to the proposed charter flight or any land tour? Yes [] No []

4. Does the agent have any financial interest in any organization rendering services to the chartering organization?

Yes [] No []. If answer is “yes” explain: Warranty 2

I, ——————————(Name) represent and warrant that I have acted with regard to this charter operation (except to the extent fully and specifically explained in part II, section A) and will act with regard to such operation in a manner consistent with part 208 of the Board's economic regulations.

(Date)

(Signature and address of travel agent or, if none, of authorized official of air carrier where such carrier or an affiliate under its control performs any travel agency function or service (excluding air transportation sales but including land tour arrangements).) Section B—To be supplied by charterer:

1. Description of chartering organization, including its objective and purposes:

2. What activities are sponsored by the chartering organization?

3. When was the organization founded?

4. Qualification or requirements for membership in organization and membership fee, if any:

5. Has there been any reference to pro-spective charter flights in soliciting new members for the charter organization?

Yes [] No []

6. State where a list of members is available for inspection.

7. Attach list of prospective passengers (including “standbys” and one-way passengers designated as such), showing for each: (a) Name, address, and telephone number; (b) relationship of such person to chartering organization, i.e., member, spouse, dependent child, parent or “special” (a person whose proposed participation in the charter flight was permitted by the Board pursuant to request for waiver); (c) if such person is related to a member who is not a prospective passenger, the member's name, address, and telephone number; and (d) date member joined or last renewed a lapsed membership. (Note: This is a list of prospective passengers, and does not necessarily have to represent the passengers actually to be carried. The list is to the amended, if passengers are dropped or added before flights and the certification required by § 208.215 must be attached to the list.)

8. What are requirements for participation in charter?

9. How were prospective participants for charter solicited (attach any solicitation material)?

10. Will there be any participants in the charter flight other than (1) members of the chartering organization or (2) spouse, dependent children, and parents of a member of the chartering group residing in the same household with the member?

Yes [] No []

11. Will there by any members of the charter organization participating in the charter who will have been members of the organization for a period of less than 6 months prior to flight date? 3 Yes [ ] No [ ]. If answer is “yes,” give names of participants who will not have been members for 6 months:

12. If there is any intermediary involved in the charter, other than the travel agent whose participation is described in part II, section A, submit name, address, remuneration, and scope of activity:

13. Estimated receipts: —————— (Pro rata charge)×—————— (No. of passengers)=$—————— (Estimated receipts from charter).

Estimated receipts from other sources, if any:

Explain:

(a) Total receipts. $——————Estimated expenditures, including aircraft charter (separately itemize air transportation, land tour, and administrative expenses):

ItemAmountPayable to

(b) Total expenditures: $———

Explain any difference between (a) and (b):

14. Are any of the expenses included in item 13 above, to be paid to any members of the chartering organization? Yes [ ] No [ ]. If “yes” state how much, to whom and for what services:

15. Is any member of the chartering organization to receive any compensation or benefit directly or indirectly from the air carrier, the travel agent, or any organization providing services in relation to the air or land portion of the trip? Yes [] No []. If “yes” explain fully:

16. Will any person in the group (except children under 2 years) be transported without charge? Yes [] No []

17. Will charter costs be divided equally among charter participants, except to the extent that a lesser charge is made for children under 12 years old? Yes [] No []

18. Separately state for the outbound and inbound flights the number of one-way passengers anticipated to be transported in each direction:

19. If four or more round trips are contracted for, will each group move as a unit in both directions? Yes [] No []

20. If charters have been performed for organization during past 5 years, give dates and name of carrier performing charters:

21. Has a copy of part 208 “Terms, Conditions and Limitations of Certificates to engage in Supplemental Air Transportation,” of the economic regulations of the Civil Aeronautics Board been received by the charterer? Yes [] No []

22. Attach copies of all announcements of the chartering organization in connection with the charter issued after the charter contract is signed.

Warranty of Charterer 4

I, —————————— (Name) and —————————— (Name) represent and warrant that the charterer has acted with regard to this charter operation explained in part II, section B), and will act with regard to such operation, in a manner consistent with part 208 of the Board's Economic Regulations. I (we) further represent and warrant that the charterer has not offered charter flights simultaneously with the solicitation of membership in the chartering organization in any mass media advertising or notice or through direct mailing or public posters. I (we) further represent and warrant that all charter participants have been informed of eligibility and cost requirements of part 208 and that a flight may be canceled if ineligible participants are included.

(Date)

(Signature—person within organization in charge of charter arrangements) (Signature and title of officer. This should be the chief officer of the chartering organization except in the case of a school charter, in which case the warranty must be by school official not directly involved in charter.) Warranty of Air Carrier 5

To the best of my knowledge and belief all the information presented in this statement, including but not limited to, those parts warranted by the charterer and the travel agent, is true and correct. I represent and warrant that the carrier has acted with regard to this charter operation (except to the extent fully and specifically explained in this statement or any attachment thereto) and will act with regard to such operation in a manner consistent with part 208 of the Board's economic regulations.

(Date)

(Signature and title of authorized official of air carrier)

Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals, or covers up by any trick, scheme, or device a material fact, or makes any false, fictitious, or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious, or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than 5 years, or both. (18 U.S.C. 1001).