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

Available versions for ERULES-1963177438-4098

Regulation (EU) 2021/699 found in: Initial Airworthiness and Environmental Protection (No 748/2012) Part-21 Part-21L (Jul 2024)

Version Text

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

Regulation (EU) 2021/699

Appendix II

Airworthiness Review
Certificate – EASA Form 15a

<table border="1" cellpadding="0" cellspacing="0" width="603">
<tr>
<td valign="top" width="603">
[MEMBER STATE]
A Member of the European Union<a href="#_ftn42">[42]</a>
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<a href="#_ftn43">[43]</a>:
 …………………………………………………………………………………………………..
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: ………………………………………………….
</td>
</tr>
</table>

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.

<table border="1" cellpadding="0" cellspacing="0" width="603">
<tr>
<td valign="top" width="603">
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: …………………………………….......
</td>
</tr>
</table>

(\*)         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]](#_ftnref42)    Delete for non-EU Member
States.

[[43]](#_ftnref43)    Except for airships.