GM1 Article 6(1) Statement
of compliance
ED Decision 2023/016/R
STANDARD FORM
SoC No [internal numbering]
Issue No [version of this SoC[20]]
1. Name and address of ATM/ANS provider
2. Description, identification and scope of the ATM/ANS equipment
Note: It should include e.g. type, SW/HW version number and master drawing record, as applicable.
3. Regulation reference requiring the issue of the SoC
4. Specification reference, i.e. EASA detailed specification No.
5. Reference to the qualification test report to show compliance with the applicable detailed specifications and the procedure followed in order to be compliant
6. Service and instruction manual reference number
7. SoC with the applicable EASA detailed specification, as far as applicable for the intended use, and any deviations, remarks, limitations, conditions.
8. The declaration in this document is made under the authority of ………………………………………. (Name of ATM/ANS provider or approved DPO)
(approved DPO’s name) cannot accept responsibility for equipment used outside the limiting conditions stated above without their agreement.
Date: …… Signed……………(ATM/ANS provider’s or approved DPO’s authorised representative)
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