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Appendix II — EASA Form 15a and 15c — Airworthiness Review Certificate

Regulation (EU) 2021/699

Appendix II

 

Airworthiness Review Certificate – EASA Form 15a

 

 

[MEMBER STATE]

 

A Member of the European Union[42]

 

AIRWORTHINESS REVIEW CERTIFICATE

 

ARC reference: ……….

 

Pursuant to Regulation (EU) 2018/1139 of the European Parliament and of the Council the [COMPETENT AUTHORITY OF THE MEMBER STATE] hereby certifies that the following aircraft:

Aircraft manufacturer: …………………………………………………………………………………………………………………………………..

Manufacturer's designation: ………………………………………………………………………………………………………………………….

Aircraft registration: ………………………………………………………………………………………………………………………………………

Aircraft serial number: …………………………………………………………………………………………………………………………………..

is considered airworthy at the time of the review.

 

Date of issue: …………………………………………………………….. Date of expiry: …………………………………………………………

Airframe flight hours (FH) at date of issue[43]: …………………………………………………………………………………………………..

Signed: ………………………………………………………………………. Authorisation No: ……………………………………………………

 

1st extension: The aircraft has remained in a controlled environment in accordance with point M.A.901 of Annex I (Part-M) to Commission Regulation (EU) No 1321/2014 for the last year. The aircraft is considered to be airworthy at the time of the issuance of this certificate.

Date of issue: …………………………………………………………….. Date of expiry: …………………………………………………………

Airframe flight hours (FH) at date of issue2: …………………………………………………………………………………………………..

Signed: ………………………………………………………………………. Authorisation No: …………………………………………………….

Company Name: ……………………………………………………….. Approval reference: ………………………………………………….

 

2nd extension: The aircraft has remained in a controlled environment in accordance with point M.A.901 of Annex I (Part-M) to Commission Regulation (EU) No 1321/2014 for the last year. The aircraft is considered to be airworthy at the time of the issuance of the certificate.

Date of issue: …………………………………………………………….. Date of expiry: …………………………………………………………

Airframe flight hours (FH) at date of issue2: …………………………………………………………………………………………………..

Signed: ………………………………………………………………………. Authorisation No: …………………………………………………….

Company Name: ……………………………………………………….. Approval reference: ………………………………………………….

EASA Form 15a – Issue 5

Airworthiness Review Certificate – EASA Form 15c

 

NOTE: persons and organisations performing the airworthiness review in combination with the 100‑h/annual inspection may use the reverse side of this form in order to issue the CRS referred to in point ML.A.801 corresponding to the 100‑h/annual inspection.

AIRWORTHINESS REVIEW CERTIFICATE (ARC) (for aircraft complying with Part-ML)

ARC reference: ………………

Pursuant to Regulation (EU) 2018/1139 of the European Parliament and of the Council:

[NAME OF THE COMPETENT AUTHORITY] (**)

hereby certifies that:

☐…..it has performed an airworthiness review in accordance with Regulation (EU) No 1321/2014 on the following aircraft:

[or]

☐.….the following new aircraft:

Aircraft manufacturer:………………………………….Manufacturer’s designation:…………………………………………..

Aircraft registration:……………………………………Aircraft serial number:……………………………………………………..

(and that this aircraft) is considered airworthy at the time of the review.

Date of issue: ..................................................................Date of expiry: ………………………………………………..

Airframe flight hours (FH) at date of review (*): …………………………………………………………………………..……….

Signed: ..............................................................Authorisation No (if applicable): ……………………………………

[OR]

[NAME OF APPROVED ORGANISATION, ADDRESS and APPROVAL REFERENCE] (**)

[or]

[FULL NAME OF THE CERTIFYING STAFF AND PART-66 LICENCE NUMBER (OR NATIONAL EQUIVALENT)] (**)

hereby certifies that it has performed an airworthiness review in accordance with Regulation (EU) No 1321/2014 on the following aircraft:

Aircraft manufacturer:………………………………….Manufacturer’s designation:………………………………………….

Aircraft registration:……………………………………Aircraft serial number:…………………………………………………….

and that this aircraft is considered airworthy at the time of the review.

Date of issue: ..................................................................Date of expiry: ……………………………………………….

Airframe flight hours (FH) at date of review (*): ……………………………………………………………………………………

Signed: ............................................................................Authorisation No (if applicable): ……………………………………….

===================================================================================

1st extension: The aircraft complies with the conditions of ML.A.901(c) of Annex Vb (Part-ML)

Date of issue: ..................................................................Date of expiry: …………………………………………………

Airframe flight hours (FH) at date of issue (*): ……………………………………………………………………………………….

Signed: ............................................................................Authorisation No: …………………………………………….

Company name: .............................................................Approval reference: …………………………………….......

===================================================================================

2nd extension: The aircraft complies with the conditions of ML.A.901(c) of Annex Vb (Part-ML)

Date of issue: ..................................................................Date of expiry: …………………………………………………

Airframe flight hours (FH) at date of issue (*): ……………………………………………………………………………………….

Signed: ............................................................................Authorisation No: …………………………………………….

Company name: .............................................................Approval reference: …………………………………….......

(*)         Except for balloons and airships

(**)      The issuer of the Form can tailor it to his need by deleting the name, the certifying statement, the reference to the subject aircraft and the issuance details that are not relevant for his use.

EASA Form 15c, Issue 4


[42]    Delete for non-EU Member States.

[43]    Except for airships.