OST Form 4535

OMB No. 2106-0005
Expires 04/30/2023

Paperwork Reduction Act Statement
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to
comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that Control Number for this information
collection is. 2106-0005. Public reporting for this collection of information is estimated to be approximately 30 minutes per response, including the
time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden
to: Information Collection Clearance Officer, U.S. Department of Transportation, Office of International Aviation, X-46, 1200 New Jersey Avenue SE,
Suite W-86-445, Washington, DC 20590.

STATEMENT OF DIRECT AIR CARRIER

U.S. Department of
Transportation

INSTRUCTIONS: Date of filing for purposes of DOT regulations is the date properly completed forms
received by DOT.

Office of the Secretary
of Transportation

______________________________________________________________ hereby promises that it will take
(Direct Air Carrier)

responsibility for all obligations owed by ______________________________________________________________
(Charter Operator)

to participants on charter flight schedule number __________________________________ (or other designation of
(Flight Schedule Number)

charter trip), including obligations for ground services and accommodations.

DIRECT AIR CARRIER
By: ___________________________________________
(Signature)

_______________________________________________
(Name in print)

_______________________________________________
(Title)

________________________/ ______________________
(Phone Number)

(Fax Number)

_______________________________________________
(Street, Box Number)

_______________________________________________
(City, State, Zip Code)

_______________________________________________
(Date)**

**This document is not acceptable if not dated.

OST Form 4535

OST 4530, 32-35 Form Disk