Medical Certificate Fit to Fly KLM employees (pilot or cabin attendant)

This form is a fit-to-fly statement for KLM employees to be used by doctors outside The Netherlands. After filling out the form and signing it, the form can be handed over to the KLM employee who will give it to his supervisor.

If you prefer to fill out and sign the form in print you can download the form here.

Part A: to be completed by KLM/KLC employee
Name (family name & initials)
Initials Family name
Birthday

Day
Month
Year
Gender
Address
Street + number Address line 2 City Country
E-mail*
KLM/KLC pers. nr.
Next flight (flight nr. and date)
Destination
Part B – To be completed by Medical Doctor
Name
Initials Family name
Address
City Country
Phone
E-mail*
I hereby state, that I treated the employee mentioned above. His/her medical condition is as such that he/she:*
- Not fit to fly to board te flight mentioned above
- Board the flight mentioned above as a non-working passenger
- Can board the flight mentioned above an perform his/her working duties
Date

Day
Month
Year
Handtekening
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

Medical Certificate Fit to Fly KLM employees (pilot or cabin attendant)

Part A: to be completed by KLM/KLC employee

Part B – To be completed by Medical Doctor