AMC1 DPO.OR.C.001(e) Organisations involved in the design or production of ATM/ANS equipment

• ED Decision 2024/002/R found in: ATM/ANS Equipment (2023/1769 and 2023/1768) Part-DPO Part-ATM/ANS.EQMT (Nov 2024)

AMC1 DPO.OR.C.001(e) Organisations involved in the design or production of ATM/ANS equipment ED Decision 2024/002/R EASA RELEASE FORM | STANDARD FORM <table border="1" cellpadding="0" cellspacing="0"> <tr> <td colspan="3" valign="top" width="565"> <p>ATM/ANS EQUIPMENT RELEASE FORM</p> </td> </tr> <tr> <td valign="top" width="190"> <p>1. DPO reference </p> </td> <td colspan="2" valign="top" width="375"> <p>2. Statement ref No: </p> </td> </tr> <tr> <td colspan="3" valign="top" width="565"> <p>3. ATM/ANS equipment serial number</p> </td> </tr> <tr> <td colspan="3" valign="top" width="565"> <p>4. ATM/ANS equipment model name</p> </td> </tr> <tr> <td valign="top" width="190"> <p>5. Part number </p> </td> <td colspan="2" valign="top" width="375"> <p>6. Certificate ref No: / Declaration ref No:</p> </td> </tr> <tr> <td colspan="3" valign="top" width="565"> <p>7. Description of the ATM/ANS equipment</p> </td> </tr> <tr> <td colspan="3" valign="top" width="565"> <p>8. Concessions </p> </td> </tr> <tr> <td colspan="3" valign="top" width="565"> <p>9. Exemptions, waivers or derogations </p> </td> </tr> <tr> <td colspan="3" valign="top" width="565"> <p>10. Remarks </p> </td> </tr> <tr> <td colspan="3" valign="top" width="565"> <p>11. Statement of Conformity </p> <p>It is hereby certified that this ATM/ANS equipment conforms fully to the certificated design/the declaration of design compliance and to the items above in boxes 7, 8, 9 and 10. </p> <p>The ATM/ANS equipment is manufactured in compliance with Implementing Regulation (EU) 2023/1769. </p> </td> </tr> <tr> <td valign="top" width="190"> <p>12. Signed </p> </td> <td valign="top" width="190"> <p>13. Name </p> </td> <td valign="top" width="185"> <p>14. Date (d/m/y)</p> </td> </tr> <tr> <td colspan="3" valign="top" width="565"> <p>15. DPO Approval Reference </p> </td> </tr> </table> Block 1: The full name and the address of the location of the DPO that issues the statement. This block may be preprinted. Logos, etc. are permitted if the logo, etc. can be contained within the block. Block 2: A unique form tracking number established by the numbering system/procedure of the DPO must be indicated. Block 3: The serial number identification linked to a specific item assigned by the organisation involved in the production for control and traceability and product support purposes. Block 4: The ATM/ANS equipment model name in full as specified in the certificate or declaration of design compliance. Block 5: The part number identification of the ATM/ANS equipment, as it appears on the equipment marking, and on the certificate/declaration of design compliance. Block 6: Reference to the certificate or declaration of design compliance reference numbers for the subject ATM/ANS equipment. Block 7: Brief description of the ATM/ANS equipment, including its main functionalities. Block 8: Unintentional differences from the approved design, referred to as ‘concessions’. Block 9: Only agreed[[13]](#_ftn13) exemptions, waivers or derogations may be included here. Block 10: Any statement, information, particular data or limitation which may affect the compliance of the ATM/ANS equipment. If there is no such information or data, state ‘NONE’. List the design changes to the ATM/ANS equipment, under approved design data, and reference all the applicable ATM/ANS equipment directives (or equivalent) that have been applied on the equipment. Block 11: The validity of the EASA release form is subject to the full completion of all the blocks on the form. Block 12: The EASA release form is signed by an authorised person. Block 13: The name of the person that signs the statement. Block 14: The date on which the EASA release form is signed should be given. Block 15: The EASA DPO approval reference should be quoted. --- [[13]](#_ftnref13) ‘agreed’ refers to agreement between the approved DPO and EASA.