Appendix I -- EASA Form 1 -- Authorised Release Certificate

• Regulation (EU) No 69/2014 found in: Initial Airworthiness and Environmental Protection (748/2012) Part-21 Part-21L (Jul 2024)

Appendix I — EASA Form 1 — Authorised Release Certificate Regulation (EU) No 69/2014 Appendix I Authorised Release Certificate — EASA Form 1 referred to in Annex I (Part 21) <table border="1" cellpadding="0" cellspacing="0" width="931"> <tr> <td colspan="3" valign="top" width="274"> <p>1. Approving Competent Authority / Country</p> </td> <td colspan="5" valign="top" width="427"> <p>2. AUTHORISED RELEASE CERTIFICATE</p> <p>EASA FORM 1</p> </td> <td valign="top" width="230"> <p>3. Form Tracking Number</p> </td> </tr> <tr> <td colspan="8" valign="top" width="701"> <p>4. Organisation Name and Address:</p> </td> <td valign="top" width="230"> <p>5. Work Order/Contract/Invoice</p> </td> </tr> <tr> <td valign="top" width="155"> <p>6. Item</p> </td> <td colspan="3" valign="top" width="155"> <p>7. Description</p> </td> <td valign="top" width="155"> <p>8. Part No.</p> </td> <td valign="top" width="118"> <p>9. Qty.</p> </td> <td colspan="2" valign="top" width="118"> <p>10. Serial No.</p> </td> <td valign="top" width="230"> <p>11. Status/Work</p> </td> </tr> <tr> <td valign="top" width="155"> </td> <td colspan="3" valign="top" width="155"> </td> <td valign="top" width="155"> </td> <td valign="top" width="118"> </td> <td colspan="2" valign="top" width="118"> </td> <td valign="top" width="230"> </td> </tr> <tr> <td colspan="9" valign="top" width="931"> <p>12. Remarks</p> </td> </tr> <tr> <td colspan="5" valign="top" width="465"> <p>13a. Certifies that the items identified above were manufactured in conformity to:</p> <p>□ approved design data and are in a condition for safe operation</p> <p>□ non-approved design data specified in block 12</p> </td> <td colspan="4" valign="top" width="466"> <p>14a □ Part-145.A.50 Release to Service □ Other regulation specified in block 12</p> <p>Certifies that unless otherwise specified in block 12, the work identified in block 11 and described in block 12, was accomplished in accordance with Part-145 and in respect to that work the items are considered ready for release to service.</p> </td> </tr> <tr> <td colspan="2" valign="top" width="233"> <p>13b. Authorised Signature</p> </td> <td colspan="3" valign="top" width="233"> <p>13c. Approval/Authorisation Number</p> </td> <td colspan="2" valign="top" width="233"> <p>14b. Authorised Signature</p> </td> <td colspan="2" valign="top" width="233"> <p>14c. Certificate/Approval Ref. No.</p> </td> </tr> <tr> <td colspan="2" valign="top" width="233"> <p>13d. Name</p> </td> <td colspan="3" valign="top" width="233"> <p>13e. Date (dd mmm yyyy)</p> </td> <td colspan="2" valign="top" width="233"> <p>14d. Name</p> </td> <td colspan="2" valign="top" width="233"> <p>14e. Date (dd mmm yyyy)</p> </td> </tr> <tr> <td colspan="9" valign="top" width="931"> <p>USER/INSTALLER RESPONSIBILITIES</p> </td> </tr> <tr> <td colspan="9" valign="top" width="931"> <p>This certificate does not automatically constitute authority to install the item(s).</p> <p>Where the user/installer performs work in accordance with regulations of an airworthiness authority different than the airworthiness authority specified in block 1, it is essential that the user/installer ensures that his/her airworthiness authority accepts items from the airworthiness authority specified in block 1.</p> <p>Statements in blocks 13a and 14a do not constitute installation certification. In all cases aircraft maintenance records must contain an installation certification issued in accordance with the national regulations by the user/installer before the aircraft may be flown.</p> </td> </tr> <tr height="0"> </tr> </table> EASA Form 1-21 Issue 2. #### Appendix I — EASA Form 1 — Authorised Release Certificate *Regulation (EU) No 69/2014* *Appendix I* **Authorised Release Certificate — EASA Form 1 referred to in Annex I (Part 21)** <table cellpadding="7" cellspacing="0"> <col/> <col/> <col/> <col/> <col/> <col/> <col/> <col/> <col/> <tbody> <tr valign="top"> <td colspan="3"><p align="left"> 1. Approving Competent Authority / Country</p> </td> <td colspan="5"><p align="left"> <br/> </p> <p align="left"> <b>2. AUTHORISED RELEASE CERTIFICATE</b></p> <p align="left"><b>EASA FORM 1</b></p> </td> <td><p align="left"> 3. Form Tracking Number</p> </td> </tr> </tbody> <tbody> <tr valign="top"> <td colspan="8"><p align="left"> 4. Organisation Name and Address:</p> </td> <td><p align="left"> 5. Work Order/Contract/Invoice</p> </td> </tr> </tbody> <tbody> <tr valign="top"> <td><p align="left"> 6. Item</p> </td> <td colspan="3"><p align="left"> 7. Description</p> </td> <td><p align="left"> 8. Part No.</p> </td> <td><p align="left"> 9. Qty.</p> </td> <td colspan="2"><p align="left"> 10. Serial No.</p> </td> <td><p align="left"> 11. Status/Work</p> </td> </tr> </tbody> <tbody> <tr valign="top"> <td><p align="left"> <br/> </p> </td> <td colspan="3"><p align="left"> <br/> </p> </td> <td><p align="left"> <br/> </p> </td> <td><p align="left"> <br/> </p> </td> <td colspan="2"><p align="left"> <br/> </p> </td> <td><p align="left"> <br/> </p> </td> </tr> </tbody> <tbody> <tr> <td colspan="9" valign="top"><p align="left"> 12. Remarks</p> </td> </tr> </tbody> <tbody> <tr valign="top"> <td colspan="5"><p> 13a. Certifies that the items identified above were manufactured in conformity to:</p> <p> □ approved design data and are in a condition for safe operation</p> <p> □ non-approved design data specified in block 12</p> </td> <td bgcolor="#d9d9d9" colspan="4"><p align="left"> 14a □ Part-145.A.50 Release to Service □ Other regulation specified in block 12</p> <p align="left">Certifies that unless otherwise specified in block 12, the work identified in block 11 and described in block 12, was accomplished in accordance with Part-145 and in respect to that work the items are considered ready for release to service.</p> </td> </tr> </tbody> <tbody> <tr valign="top"> <td colspan="2"><p align="left"> 13b. Authorised Signature</p> <p align="left"><br/> </p> </td> <td colspan="3"><p align="left"> 13c. Approval/Authorisation Number</p> </td> <td bgcolor="#d9d9d9" colspan="2"><p align="left"> 14b. Authorised Signature</p> </td> <td bgcolor="#d9d9d9" colspan="2"><p align="left"> 14c. Certificate/Approval Ref. No.</p> </td> </tr> </tbody> <tbody> <tr valign="top"> <td colspan="2"><p align="left"> 13d. Name</p> </td> <td colspan="3"><p align="left"> 13e. Date (dd mmm yyyy)</p> </td> <td bgcolor="#d9d9d9" colspan="2"><p align="left"> 14d. Name</p> </td> <td bgcolor="#d9d9d9" colspan="2"><p align="left"> 14e. Date (dd mmm yyyy)</p> </td> </tr> </tbody> <tbody> <tr> <td colspan="9" valign="top"><p align="left"> USER/INSTALLER RESPONSIBILITIES</p> </td> </tr> <tr> <td colspan="9" valign="top"><p align="left"> This certificate does not automatically constitute authority to install the item(s).</p> <p align="left"> Where the user/installer performs work in accordance with regulations of an airworthiness authority different than the airworthiness authority specified in block 1, it is essential that the user/installer ensures that his/her airworthiness authority accepts items from the airworthiness authority specified in block 1.</p> <p align="left">Statements in blocks 13a and 14a do not constitute installation certification. In all cases aircraft maintenance records must contain an installation certification issued in accordance with the national regulations by the user/installer before the aircraft may be flown.</p> </td> </tr> </tbody> </table> ***EASA Form 1-21 Issue 2.***