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

Available versions for ERULES-1963177438-21309

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

Version Text

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">
CERTIFICATE OF RELEASE
 TO SERVICE
[PRODUCTION ORGANISATION NAME]
Production
 organisation reference:
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).
Aircraft: ………………...Type:
 ………………...…Constructor No/Registration: ……………...………….
has been maintained as specified in work
 order: ……………………………………………………………..
Brief description of work performed:
Certifies 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.
Certifying staff (name):
(signature):
Location:
Date: . . - . . - . . . . (day, month,
 year)
</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).