Appendix IX -- EASA Form 53 -- Certificate of Release to Service

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

Appendix IX — EASA Form 53 — Certificate of Release to Service Regulation (EU) No 748/2012 Appendix IX <table border="1" cellpadding="0" cellspacing="0" width="603"> <tr> <td valign="top" width="603"> <p>CERTIFICATE OF RELEASE TO SERVICE</p> <p>[APPROVED PRODUCTION ORGANISATION NAME]</p> <p>Production organisation approval Reference:</p> <p>Certificate of release to service in accordance with <a href="#_DxCrossRefBm1649096916">21.A.163(d)</a>.</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>Certifies that the work specified was carried out in accordance with <a href="#_DxCrossRefBm1649096916">21.A.163(d)</a> 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 53 COMPLETION INSTRUCTIONS The Block BRIEF DESCRIPTION OF WORK PERFORMED appearing in EASA FORM 53 should include reference to the approved data used to perform the work. The Block LOCATION appearing in EASA FORM 53 refers to the location where the maintenance has been performed, not to the location of the facilities of the organisation (if different). #### Appendix IX — EASA Form 53 — Certificate of Release to Service *Regulation (EU) No 748/2012* *Appendix IX* <table cellpadding="7" cellspacing="0"> <col/> <tr> <td valign="top"><p align="center"> <br/> </p> <p align="center"> <br/> </p> <p align="center"> <b>CERTIFICATE OF RELEASE TO SERVICE</b></p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> [APPROVED PRODUCTION ORGANISATION NAME]</p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> <b>Production organisation approval Reference:</b></p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> Certificate of release to service in accordance with <u><a href="#_DxCrossRefBm485230407">21.A.163(d)</a></u><b>.</b></p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> Aircraft: ………………...…………. Type: ………………...…………. Constructor No/Registration: ………………...………….</p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> has been maintained as specified in Work Order: ……………………………………………………………………………………..</p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> Brief description of work performed:</p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> <b>Certifies</b> that the work specified was carried out in accordance with <u><a href="#_DxCrossRefBm485230407">21.A.163(d)</a></u> 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 align="left"> <br/> </p> <p align="left"> Certifying Staff (name):</p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> (signature):</p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> Location:</p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> Date: . . - . . - . . . . (day, month, year)</p> <p align="left"> <br/> </p> <p align="left"><br/> </p> </td> </tr> </table> ***EASA Form 53*** **COMPLETION INSTRUCTIONS** The Block BRIEF DESCRIPTION OF WORK PERFORMED appearing in EASA FORM 53 should include reference to the approved data used to perform the work. The Block LOCATION appearing in EASA FORM 53 refers to the location where the maintenance has been performed, not to the location of the facilities of the organisation (if different).