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Appendix III --EASA Form 52B -- Aircraft statement of conformity

Available versions for ERULES-1963177438-21307

Regulation (EU) 2022/1358 found in: Initial Airworthiness and Environmental Protection (No 748/2012) Part-21 Part-21L (Jul 2024)

Version Text

Appendix III —EASA Form 52B — Aircraft statement of conformity

Regulation (EU) 2022/1358

Appendix III

Aircraft statement of
conformity — EASA Form 52B

<table border="0" cellpadding="0" cellspacing="0" width="603">
<tr>
<td colspan="5" valign="top" width="603">
AIRCRAFT STATEMENT OF
 CONFORMITY
</td>
</tr>
<tr>
<td valign="top" width="154">
1.       State
 of manufacture
</td>
<td colspan="3" valign="top" width="298">
2.       [MEMBER
 STATE] A Member of the European Union
</td>
<td valign="top" width="152">
3.       Statement
 Ref. No:
</td>
</tr>
<tr>
<td colspan="5" width="603">
4.       Organisation
</td>
</tr>
<tr>
<td colspan="2" width="310">
5.       Aircraft
 type
</td>
<td colspan="3" width="294">
6.       Type
 certificate/Declaration of design compliance refs:
</td>
</tr>
<tr>
<td colspan="2" width="310">
7.       Aircraft
 registration or mark
</td>
<td colspan="3" width="294">
8.       Production
 organisation identification No
</td>
</tr>
<tr>
<td colspan="5" width="603">
9.       Engine/propeller
 details 5
</td>
</tr>
<tr>
<td colspan="5" width="603">
10.     Modifications
 and/or service bulletins 1
</td>
</tr>
<tr>
<td colspan="5" width="603">
11.     Airworthiness
 directives
</td>
</tr>
<tr>
<td colspan="5" width="603">
12.     Concessions
</td>
</tr>
<tr>
<td colspan="5" width="603">
13.     Exemptions,
 waivers or derogations 1
</td>
</tr>
<tr>
<td colspan="5" width="603">
14.     Remarks
</td>
</tr>
<tr>
<td colspan="5" width="603">
15.     Restricted/certificate
 of airworthiness
</td>
</tr>
<tr>
<td colspan="5" width="603">
16.     Additional
 requirements
</td>
</tr>
<tr>
<td colspan="5" valign="top" width="603">
17.     Statement
 of conformity
It is hereby certified that this aircraft
 conforms fully to the: 
□ type-certified design; or 
□ declared design data
and to the items above in boxes 9, 10, 11,
 12 and 13.
The aircraft is in a condition for safe
 operation.
The aircraft has been satisfactorily
 tested in flight.
</td>
</tr>
<tr>
<td width="154">
18.     Signed
</td>
<td colspan="2" width="298">
19.     Name
</td>
<td colspan="2" width="152">
20.     Date
 (d/m/y)
</td>
</tr>
<tr>
<td colspan="5" width="603">
21.     Declared
 or approved production organisation reference (if applicable)
</td>
</tr>
<tr height="0">
</tr>
</table>

***EASA Form 52B — Issue 1***

(5) Delete as applicable

**Instructions
for the use of the ‘Aircraft statement of conformity — EASA Form 52B’**

1.       PURPOSE
AND SCOPE

1.1.    The
purpose of the aircraft statement of conformity ([EASA Form 52B](#_DxCrossRefBm1649097273)) issued under Subpart G
or Subpart R of Section A of Annex Ib (Part 21 Light)
or under Subpart G of Section A of Annex I (Part 21) is to
enable the production organisation to apply for an individual aircraft
certificate of airworthiness or restricted certificate of airworthiness from
the competent authority of the Member State of registry.

2.       GENERAL

2.1.    The
statement of conformity must comply with the model format, including the block
numbers and the location of each block. The size of each block may, however,
be varied to suit the individual application, but not to the extent that would
render the statement of conformity unrecognisable. If in doubt, consult the
competent authority.

2.2.    The
statement of conformity must be either pre-printed or computer generated, but
in either case, the printing of lines and characters must be clear and
legible. Pre-printed wording is permitted in accordance with the attached
model, but no other certification statements are permitted.

2.3.    The
completion of the statement may be either machine/computer-printed or
handwritten, using block letters to allow for easy reading. English, and where
relevant, one or more of the official language(s) of the issuing Member State,
are acceptable.

2.4.    A
copy of the statement and all the referenced attachments are to be retained by
the approved production organisation.

3.       COMPLETION
OF THE STATEMENT OF CONFORMITY BY THE ORIGINATOR

3.1.    There
should be an entry in all blocks to render the document a valid statement.

3.2.    A
statement of conformity may not be issued to the competent authority of the
Member State of registry unless the design of the aircraft and its installed
products are approved or the declaration of design compliance is registered
with the Agency.

3.3.    The
information required in blocks 9, 10, 11, 12, 13 and 14 may be by
reference to separate identified documents held on file by the production
organisation, unless the competent authority agrees otherwise.

3.4.    This
statement of conformity is not intended to include those items of equipment
that may be required to be fitted in order to satisfy the applicable
operational rules. However, some of these individual items may be included in
block 10 or in the approved type design or the declared aircraft design.
Operators are therefore reminded of their responsibility to ensure compliance
with the applicable operational rules for their own particular operations.

*Block
1*        Enter
the name of the State of manufacture.

*Block 2*        The competent
authority that issues the statement of conformity under its authority.

*Block 3*        A unique serial number
should be pre-printed in this block for statement control and traceability
purposes. An exception is in the case of a computer-generated document: the
number need not be pre-printed where the computer is programmed to produce and
print a unique number.

*Block 4*        The full name and the
address of the location of the organisation that issues the statement. This
block may be pre-printed. Logos, etc., are permitted if the logo, etc., can be
contained within the block.

*Block 5*        The aircraft type in
full as defined in the type certificate and its associated data sheet or the
declared aircraft design as registered by the Agency

*Block 6*        The type-certificate
reference numbers and issue for the subject aircraft or the registration
number of the declaration of design compliance

*Block 7* If the
aircraft is registered, then this mark will be the registration mark. If the
aircraft is not registered, then this will be the mark that is accepted by the
competent authority of the Member State and, if applicable, by the competent
authority of a third country.

*Block 8*        The identification
number assigned by the production organisation for control and traceability
and product support purposes. This is sometimes referred to as a ‘production
organisation serial number’ or ‘constructor’s number’.

*Block 9* The engine
type and the propeller type(s) in full as defined in the relevant type
certificate and its associated data sheet or the registered declaration of
design compliance. Their production organisation identification/reference
number and the associated location should also be stated.

*Block
10* Approved
or declared design changes to the aircraft definition

*Block 11*      A listing of all the
applicable airworthiness directives (or equivalent) and a declaration of
compliance with the airworthiness directives, together with a description of
the method of compliance of the subject individual aircraft, including
products and installed parts, appliances and equipment. Any future compliance
requirement time should be stated.

*Block 12*      Approved or declared
unintentional deviations from the approved type design or declared design,
sometimes referred to as ‘concessions’, ‘divergences’ or ‘non-conformances’.

*Block 13* Only agreed
or declared exemptions, waivers or derogations may be included here.

*Block 14*      Remarks. Any statement,
information, particular data or limitation which may affect the airworthiness
of the subject aircraft. If there is no such information or data, state
‘NONE’.

*Block 15*      Enter ‘certificate of
airworthiness’, or ‘restricted certificate of airworthiness’, as the
certificate of airworthiness requested.

*Block 16*      Additional requirements
such as those notified by an importing country should be noted in this block.

*Block 17*      The validity of the
statement of conformity is subject to the full completion of all the blocks on
the form. A copy of the flight test report, together with any recorded defects
and rectification details, should be kept on file by the production organisation.
The report should be signed as satisfactory by the appropriate certifying
staff and a flight crew member, e.g. the test pilot or the flight test
engineer.

The flight tests performed are those defined
under the control of the quality management element of the production system,
as established by either:

1.       point (b)
of point [21L.A.124](#_DxCrossRefBm1649097758); or

2.       point (f)
of point [21L.A.273](#_DxCrossRefBm1649097756),

to ensure that the aircraft conforms to the
applicable design data, and is in a condition for safe operation.

The listing of items provided (or made
available) to satisfy the aspects of this statement that relate to the safe
operation of the aircraft should be kept on file by the production
organisation.

*Block 18* The statement
of conformity may be signed by the person that is authorised to do so by the
production organisation in accordance with point (d) of point [21L.A.125](#_DxCrossRefBm1649097746) or point (b) of point [21L.A.273](#_DxCrossRefBm1649097756). A rubber stamp signature should
not be used.

*Block 19*      The name of the person
that signs the statement should be typed or printed in a legible form.

*Block
20*      The
date on which the statement of conformity is signed should be given.

*Block
21*      The
competent authority approval reference should be quoted.