Appendix IV -- EASA Form 53B -- Certificate of release to service

• Regulation (EU) 2022/1358 found in: Initial Airworthiness and Environmental Protection (748/2012) Part-21 Part-21L (Jul 2024)

Appendix IV — EASA Form 53B — Certificate of release to service Regulation (EU) 2022/1358 Appendix IV Certificate of release to service — EASA Form 53B <table border="0" cellpadding="0" cellspacing="0" width="603"> <tr> <td valign="top" width="603"> <p align="center"><b>CERTIFICATE OF RELEASE TO SERVICE</b></p> <p>[PRODUCTION ORGANISATION NAME]</p> <p><b>Production organisation reference:</b></p> <p>Certificate of release to service in accordance with <a href="#_DxCrossRefBm1649097750">21L.A.126</a>(e) or <a href="#_DxCrossRefBm1649097756">21L.A.273</a>(8) of Annex Ib (Part 21 Light) to Regulation (EU) No 748/2012 (delete as appropriate).</p> <p>Aircraft: ………………...Type: ………………...…Constructor No/Registration: ……………...………….</p> <p>has been maintained as specified in work order: ……………………………………………………………..</p> <p>Brief description of work performed:</p> <p><b>Certifies</b> that the work specified was carried out in accordance with <a href="#_DxCrossRefBm1649097750">21L.A.126</a>(e) or <a href="#_DxCrossRefBm1649097756">21L.A.273</a>(8) of Annex Ib (Part 21 Light) to Regulation (EU) No 748/2012 (delete as appropriate) and in respect to that work the aircraft is considered ready for release to service and therefore is in a condition for safe operation.</p> <p>Certifying staff (name):</p> <p>(signature):</p> <p>Location:</p> <p>Date: . . - . . - . . . . (day, month, year)</p> </td> </tr> </table> ***EASA Form 53B — Issue 1*** **COMPLETION INSTRUCTIONS** The Block BRIEF DESCRIPTION OF WORK PERFORMED appearing in EASA FORM 53B should include a reference to the approved data used to perform the work. The Block LOCATION appearing in EASA FORM 53B refers to the location where the maintenance has been performed, not to the location of the facilities of the organisation (if different). #### Appendix IV — EASA Form 53B — Certificate of release to service *Regulation (EU) 2022/1358* *Appendix IV* **Certificate of release to service — EASA Form 53B** <table cellpadding="7" cellspacing="0"> <col/> <tr> <td valign="top"><p> <br/> <br/> </p> <p align="center"> <b>CERTIFICATE OF RELEASE TO SERVICE</b></p> <p> <br/> <br/> </p> <p> [PRODUCTION ORGANISATION NAME]</p> <p> <br/> <br/> </p> <p> <br/> <br/> </p> <p> <b>Production organisation reference:</b></p> <p> <br/> <br/> </p> <p> Certificate of release to service in accordance with <u><a href="#_DxCrossRefBm485231246">21L.A.126</a></u>(e) or <u><a href="#_DxCrossRefBm485231252">21L.A.273</a></u>(8) of Annex Ib (Part 21 Light) to Regulation (EU) No 748/2012 (delete as appropriate).</p> <p> <br/> <br/> </p> <p> Aircraft: ………………...Type: ………………...…Constructor No/Registration: ……………...………….</p> <p> <br/> <br/> </p> <p> has been maintained as specified in work order: ……………………………………………………………..</p> <p> <br/> <br/> </p> <p> Brief description of work performed:</p> <p> <br/> <br/> </p> <p> <br/> <br/> </p> <p> <b>Certifies</b> that the work specified was carried out in accordance with <u><a href="#_DxCrossRefBm485231246">21L.A.126</a></u>(e) or <u><a href="#_DxCrossRefBm485231252">21L.A.273</a></u>(8) of Annex Ib (Part 21 Light) to Regulation (EU) No 748/2012 (delete as appropriate) and in respect to that work the aircraft is considered ready for release to service and therefore is in a condition for safe operation.</p> <p> <br/> <br/> </p> <p> Certifying staff (name):</p> <p> <br/> <br/> </p> <p> (signature):</p> <p> <br/> <br/> </p> <p> <br/> <br/> </p> <p> Location:</p> <p> <br/> <br/> </p> <p>Date: . . - . . - . . . . (day, month, year)</p> </td> </tr> </table> ***EASA Form 53B — Issue 1*** **COMPLETION INSTRUCTIONS** The Block BRIEF DESCRIPTION OF WORK PERFORMED appearing in EASA FORM 53B should include a reference to the approved data used to perform the work. The Block LOCATION appearing in EASA FORM 53B refers to the location where the maintenance has been performed, not to the location of the facilities of the organisation (if different).