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Appendix IV -- EASA Form 12

Available versions for ERULES-1963177438-499

ED Decision 2020/002/R found in: Continuing Airworthiness (1321/2014) Part-M Part-145 Part-66 Part-147 Part-T Part-ML Part-CAMO Part-CAO (Jul 2024)

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Appendix IV — EASA Form 12

ED Decision 2020/002/R

<table border="1" cellpadding="0" cellspacing="0" width="605"><tr><td valign="top" width="321">EASA FORM 12Page 1</td><td colspan="2" valign="top" width="283">APPLICATION FOR PART-147 INITIAL / CHANGE OF APPROVAL</td></tr><tr><td colspan="3" valign="top" width="605">Registered Name &amp; Address of Applicant:Trading Name (if different):Addresses Requiring Approval:Tel No:....................................Fax No..................................E Mail.........................................</td></tr><tr><td colspan="3" valign="top" width="605">Scope of <a href="#_DxCrossRefBm1518544911">Part-147</a> Approval Relevant to This Initial */ Change of * Application(See other side for training course designators to be used):Basic Training:Type Training:Provide reference to other approvals under the Basic Regulation:* Cross out whichever is not applicable</td></tr><tr><td colspan="2" valign="top" width="397">Name &amp; Position of Accountable Manager: Signature of Accountable Manager: Date of Application:Please send this form with any required fee to be paidunder National Legislation to your National Aviation Authority</td><td valign="top" width="208">Space for official use</td></tr><tr height="0"></tr></table>

##### Appendix IV — EASA Form 12

*ED Decision 2020/002/R*

<table cellpadding="7" cellspacing="0">
<col/>
<col/>
<col/>
<tr valign="top">
<td>
EASA
			FORM 12
Page
			1
</td>
<td colspan="2">
APPLICATION
			FOR PART-147 

INITIAL
			/ CHANGE OF APPROVAL
</td>
</tr>
<tr>
<td colspan="3" valign="top">
 


Registered
			Name &amp; Address of Applicant:

 


 


 


Trading
			Name (if different):

Addresses
			Requiring Approval:

 


 


 


Tel
			No:....................................Fax
			No..................................E
			Mail.........................................

 

 

</td>
</tr>
<tr>
<td colspan="3" valign="top">
 


Scope
			of <a href="#_DxCrossRefBm1203439798">Part-147</a>
			Approval Relevant to This Initial */ Change of * Application

(See
			other side for training course designators to be used):

 


 


Basic
			Training:

 


 


 


 


Type
			Training:

 


 


 


Provide
			reference to other approvals under the Basic Regulation:

 


 


 

*
			Cross out whichever is not applicable
</td>
</tr>
<tr valign="top">
<td colspan="2">
 


Name
			&amp; Position of Accountable Manager: 
			 


Signature
			of Accountable Manager: 


Date
			of Application:

Please
			send this form with any required fee to be paid
under
			National Legislation to your National Aviation Authority
</td>
<td>
 

Space
			for official use
</td>
</tr>
</table>

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Appendix IV -- EASA Form 12

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