Appendix V -- Application Form -- EASA Form 19

• Regulation (EU) 2021/700 found in: Continuing Airworthiness (1321/2014) Part-M Part-145 Part-66 Part-147 Part-T Part-ML Part-CAMO Part-CAO (Jul 2024)

Appendix V — Application Form — EASA Form 19 Regulation (EU) 2021/700 1. This Appendix contains an example of the form used for applying for the aircraft maintenance licence referred to in [Annex III (Part-66)](#_DxCrossRefBm1518544900). 2. The competent authority of the Member State may modify the EASA Form 19 only to include additional information necessary to support the case where the national requirements permit or require the aircraft maintenance licence issued in accordance with Annex III (Part-66) to be used outside the requirements of this Regulation. <table border="1" cellpadding="0" cellspacing="0" width="604"><tr><td colspan="9" valign="top" width="490"><br clear="all"/><p>APPLICATION FOR INITIAL/AMENDMENT/RENEWAL OF PART-66 AIRCRAFT MAINTENANCE LICENCE (AML)</p></td><td colspan="4" valign="top" width="114"><p>EASA FORM 19</p></td></tr><tr><td colspan="13" valign="top" width="604"><p>APPLICANT’S DETAILS:</p><p>Name: ………………………………………………………………………………………………………………………………………………………</p><p>Address: ……………………………………………………………………………………………………………………………………………………</p><p>Tel: ……………………………………………………………………….. E-mail: …………………………………………………………………….</p><p>Nationality: …………………………………………………………... Date and Place of Birth: ………………………………………….</p></td></tr><tr><td colspan="13" valign="top" width="604"><p>PART-66 AML DETAILS (if applicable): </p><p>Licence No: …………………………………………………………………. Date of Issue: …………………………………………………….</p></td></tr><tr><td colspan="13" valign="top" width="604"><p>EMPLOYER’S DETAILS:</p><p>Name: ………………………………………………………………………………………………………………………………………………………</p><p>Address: ……………………………………………………………………………………………………………………………………………………</p><p>………………………………………………………………………………………………………………………………………………………………….</p><p>Maintenance Organisation Approval Reference: ………………………………………………………………………………………</p><p>Tel: …………………………………………………………………………….. Fax: ……………………………………………………………………</p></td></tr><tr><td colspan="13" valign="top" width="604"><p>APPLICATION FOR: (Tick relevant boxes)</p></td></tr><tr><td colspan="2" valign="top" width="140"><p>Initial AML </p></td><td colspan="4" valign="top" width="189"><p>Amendment of AML </p></td><td colspan="7" valign="top" width="275"><p>Renewal of AML </p></td></tr><tr><td valign="top" width="131"><p>(Sub)categories</p><p>Aeroplane Turbine</p><p>Aeroplane Piston</p><p>Helicopter Turbine</p><p>Helicopter Piston</p></td><td colspan="2" valign="top" width="56"><p>A</p></td><td valign="top" width="57"><p>B1</p></td><td valign="top" width="48"><p>B2</p></td><td colspan="2" valign="top" width="95"><p>B2L</p></td><td valign="top" width="66"><p>B3</p></td><td colspan="2" valign="top" width="57"><p>C</p></td><td colspan="3" valign="top" width="94"><p>L (see below)</p></td></tr><tr><td valign="top" width="131"><p>Avionics</p></td><td colspan="2" valign="top" width="56"></td><td valign="top" width="57"></td><td valign="top" width="48"></td><td colspan="5" valign="top" width="218"><p> See system ratings below</p></td><td colspan="3" valign="top" width="94"></td></tr><tr><td colspan="7" valign="top" width="386"><p>Piston engine non-pressurised aeroplanes of MTOM of 2t and below</p></td><td valign="top" width="66"></td><td colspan="2" valign="top" width="57"></td><td colspan="3" valign="top" width="94"></td></tr><tr><td colspan="8" valign="top" width="453"><p>Complex motor-powered aircraft</p></td><td colspan="2" valign="top" width="57"></td><td valign="top" width="38"></td><td valign="top" width="19"></td><td valign="top" width="38"></td></tr><tr><td colspan="8" valign="top" width="453"><p>Aircraft other than complex motor-powered aircraft</p></td><td colspan="2" valign="top" width="57"></td><td valign="top" width="38"></td><td valign="top" width="19"></td><td valign="top" width="38"></td></tr><tr><td colspan="5" valign="top" width="292"><p>System ratings for B2L licence:</p><p>1. autoflight</p><p>2. instruments</p><p>3. com/nav</p><p>4. surveillance</p><p>5. airframe systems</p></td><td colspan="5" valign="top" width="218"></td><td valign="top" width="38"></td><td valign="top" width="19"></td><td valign="top" width="38"></td></tr><tr><td colspan="10" valign="top" width="509"><p>L-licence subcategories:</p><p>L1C: Composite sailplanes</p><p>L1: Sailplanes</p><p>L2C: Composite powered sailplanes and composite ELA1 aeroplanes</p><p>L2: Powered sailplanes and ELA1 aeroplanes</p><p>L3H: Hot-air balloons</p><p>L3G: Gas balloons</p><p>L4H: Gas balloons</p><p>L4H: Hot-air airships</p><p>L4G: ELA2 gas airships</p><p>L5: Gas airship other than ELA2</p></td><td valign="top" width="38"></td><td valign="top" width="19"></td><td valign="top" width="38"></td></tr><tr><td colspan="13" valign="top" width="604"><p>Type endorsements/Rating endorsement/Limitation removal (if applicable): …………………………………………………………………………………………………………………………………………………………………….</p></td></tr><tr><td colspan="13" valign="top" width="604"><p>I wish to apply for initial/amendment of/renewal of Part-66 AML, as indicated, and confirm that the information contained in this form was correct at the time of application.</p><p>I herewith confirm that: </p><p>1. I am not holding any Part-66 AML issued in another Member State;</p><p>2. I have not applied for any Part-66 AML in another Member State; and </p><p>3. I never had a Part-66 AML issued in another Member State which was revoked or suspended in any other Member State.</p><p>I also understand that any incorrect information could disqualify me from holding a Part-66 AML.</p><p>Signed: …………………………………………………………………. Name: ………………………………………………………………………. </p><p>Date: ………………………………………………………………………………………………………………………………………………………….</p></td></tr><tr><td colspan="13" valign="top" width="604"><p>I wish to claim the following credits (if applicable):</p><p>…………………………………………………………………………………………………………………………………………………………………….</p><p>…………………………………………………………………………………………………………………………………………………………………….</p><p>…………………………………………………………………………………………………………………………………………………………………….</p><p>Experience credits for Part-147 training</p><p>…………………………………………………………………………………………………………………………………………………………………….</p><p>…………………………………………………………………………………………………………………………………………………………………….</p><p>…………………………………………………………………………………………………………………………………………………………………….</p><p>Examination credits for equivalent exam certificates </p><p>…………………………………………………………………………………………………………………………………………………………………….</p><p>…………………………………………………………………………………………………………………………………………………………………….</p><p>…………………………………………………………………………………………………………………………………………………………………….</p><p>Please enclose all relevant certificates</p></td></tr><tr><td colspan="13" valign="top" width="604"><p>Recommendation (if applicable): It is hereby certified that the applicant has met the relevant Part-66 maintenance knowledge and experience requirements and it is recommended that the competent authority grants or endorses the Part-66 AML.</p><p>Signed: .............................................................. Name: ..................................................................................</p><p>Position: ........................................................... Date: ....................................................................................</p></td></tr><tr height="0"></tr></table> EASA Form 19 Issue 5 #### Appendix V — Application Form — EASA Form 19 *Regulation (EU) 2021/700* 1. This Appendix contains an example of the form used for applying for the aircraft maintenance licence referred to in [Annex III (Part-66)](#_DxCrossRefBm1203439787). 2. The competent authority of the Member State may modify the EASA Form 19 only to include additional information necessary to support the case where the national requirements permit or require the aircraft maintenance licence issued in accordance with Annex III (Part-66) to be used outside the requirements of this Regulation. <table cellpadding="7" cellspacing="0"> <colgroup> <col/> <col/> <col/> <col/> <col/> <col/> <col/> <col/> <col/> </colgroup> <colgroup> <col/> <col/> <col/> <col/> </colgroup> <tbody> <tr valign="top"> <td colspan="9"><p align="center"> APPLICATION FOR INITIAL/AMENDMENT/RENEWAL OF PART-66 AIRCRAFT MAINTENANCE LICENCE (AML)</p> </td> <td colspan="4"><p align="center"> EASA FORM 19</p> </td> </tr> </tbody> <tbody> <tr> <td colspan="13" valign="top"><p> APPLICANT’S DETAILS:</p> <p> Name: ………………………………………………………………………………………………………………………………………………………</p> <p> Address: ……………………………………………………………………………………………………………………………………………………</p> <p> Tel: ……………………………………………………………………….. E-mail: …………………………………………………………………….</p> <p>Nationality: …………………………………………………………... Date and Place of Birth: ………………………………………….</p> </td> </tr> </tbody> <tbody> <tr> <td colspan="13" valign="top"><p> PART-66 AML DETAILS (if applicable): </p> <p>Licence No: …………………………………………………………………. Date of Issue: …………………………………………………….</p> </td> </tr> </tbody> <tbody> <tr> <td colspan="13" valign="top"><p> EMPLOYER’S DETAILS:</p> <p> Name: ………………………………………………………………………………………………………………………………………………………</p> <p> Address: ……………………………………………………………………………………………………………………………………………………</p> <p> ………………………………………………………………………………………………………………………………………………………………….</p> <p> Maintenance Organisation Approval Reference: ………………………………………………………………………………………</p> <p>Tel: …………………………………………………………………………….. Fax: ……………………………………………………………………</p> </td> </tr> </tbody> <tbody> <tr> <td colspan="13" valign="top"><p> APPLICATION FOR: (Tick relevant boxes)</p> </td> </tr> <tr valign="top"> <td colspan="2"><p> Initial AML <input type="checkbox"/></p> </td> <td colspan="4"><p> Amendment of AML <input type="checkbox"/></p> </td> <td colspan="7"><p> Renewal of AML <input type="checkbox"/></p> </td> </tr> <tr valign="top"> <td><p align="left"> <b>(Sub)categories</b></p> <p align="left"> Aeroplane Turbine</p> <p align="left"> Aeroplane Piston</p> <p align="left"> Helicopter Turbine</p> <p align="left">Helicopter Piston</p> </td> <td colspan="2"><p align="left"> <b>A</b></p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"><input type="checkbox"/></p> </td> <td><p align="left"> <b>B1</b></p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"><input type="checkbox"/></p> </td> <td><p align="left"> <b>B2</b></p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"><br/> </p> </td> <td colspan="2"><p align="left"> <b>B2L</b></p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"><br/> </p> </td> <td><p align="left"> <b>B3</b></p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"><br/> </p> </td> <td colspan="2"><p align="left"> <b>C</b></p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"> <br/> </p> <p align="left"><br/> </p> </td> <td colspan="3"><p align="left"> <b>L (see below)</b></p> </td> </tr> <tr valign="top"> <td><p align="left"> Avionics</p> </td> <td colspan="2"><p align="left"> <br/> </p> </td> <td><p align="left"> <br/> </p> </td> <td><p align="left"> <input type="checkbox"/></p> </td> <td colspan="5"><p align="left"> <input type="checkbox"/> See system ratings below</p> </td> <td colspan="3"><p align="left"> <br/> </p> </td> </tr> <tr valign="top"> <td colspan="7"><p align="left"> Piston engine non-pressurised aeroplanes of MTOM of 2t and below</p> </td> <td><p align="left"> <input type="checkbox"/></p> </td> <td colspan="2"><p align="left"> <br/> </p> </td> <td colspan="3"><p align="left"> <br/> </p> </td> </tr> <tr valign="top"> <td colspan="8"><p align="left"> Complex motor-powered aircraft</p> </td> <td colspan="2"><p align="left"> <input type="checkbox"/></p> </td> <td><p align="left"> <br/> </p> </td> <td><p align="left"> <br/> </p> </td> <td><p align="left"> <br/> </p> </td> </tr> <tr valign="top"> <td colspan="8"><p align="left"> Aircraft other than complex motor-powered aircraft</p> </td> <td colspan="2"><p align="left"> <input type="checkbox"/></p> </td> <td><p align="left"> <br/> </p> </td> <td><p align="left"> <br/> </p> </td> <td><p align="left"> <br/> </p> </td> </tr> <tr valign="top"> <td colspan="5"><p align="left"> <b>System ratings for B2L licence:</b></p> <p align="left"> 1. autoflight</p> <p align="left"> 2. instruments</p> <p align="left"> 3. com/nav</p> <p align="left"> 4. surveillance</p> <p align="left">5. airframe systems</p> </td> <td colspan="5"><p align="left"> <br/> </p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"><input type="checkbox"/></p> </td> <td><p align="left"> <br/> </p> </td> <td><p align="left"> <br/> </p> </td> <td><p align="left"> <br/> </p> </td> </tr> <tr valign="top"> <td colspan="10"><p align="left"> <b>L-licence subcategories:</b></p> <p align="left"> L1C: Composite sailplanes</p> <p align="left"> L1: Sailplanes</p> <p align="left"> L2C: Composite powered sailplanes and composite ELA1 aeroplanes</p> <p align="left"> L2: Powered sailplanes and ELA1 aeroplanes</p> <p align="left"> L3H: Hot-air balloons</p> <p align="left"> L3G: Gas balloons</p> <p align="left"> L4H: Gas balloons</p> <p align="left"> L4H: Hot-air airships</p> <p align="left"> L4G: ELA2 gas airships</p> <p align="left">L5: Gas airship other than ELA2</p> </td> <td><p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"> <input type="checkbox"/></p> <p align="left"><input type="checkbox"/></p> </td> <td><p align="left"> <br/> </p> </td> <td><p align="left"> <br/> </p> </td> </tr> <tr> <td colspan="13" valign="top"><p align="left"> Type endorsements/Rating endorsement/Limitation removal (if applicable): …………………………………………………………………………………………………………………………………………………………………….</p> <p align="left"><br/> </p> </td> </tr> </tbody> <tbody> <tr> <td colspan="13" valign="top"><p> I wish to apply for initial/amendment of/renewal of Part-66 AML, as indicated, and confirm that the information contained in this form was correct at the time of application.</p> <p> I herewith confirm that: </p> <p> 1. I am not holding any Part-66 AML issued in another Member State;</p> <p> 2. I have not applied for any Part-66 AML in another Member State; and </p> <p> 3. I never had a Part-66 AML issued in another Member State which was revoked or suspended in any other Member State.</p> <p> I also understand that any incorrect information could disqualify me from holding a Part-66 AML.</p> <p> Signed: …………………………………………………………………. Name: ………………………………………………………………………. </p> <p>Date: ………………………………………………………………………………………………………………………………………………………….</p> </td> </tr> </tbody> <tbody> <tr> <td colspan="13" valign="top"><p align="left"> I wish to claim the following credits (if applicable):</p> <p align="left"> …………………………………………………………………………………………………………………………………………………………………….</p> <p align="left"> …………………………………………………………………………………………………………………………………………………………………….</p> <p align="left"> …………………………………………………………………………………………………………………………………………………………………….</p> <p align="left"> Experience credits for Part-147 training</p> <p align="left"> …………………………………………………………………………………………………………………………………………………………………….</p> <p align="left"> …………………………………………………………………………………………………………………………………………………………………….</p> <p align="left"> …………………………………………………………………………………………………………………………………………………………………….</p> <p align="left"> Examination credits for equivalent exam certificates </p> <p align="left"> …………………………………………………………………………………………………………………………………………………………………….</p> <p align="left"> …………………………………………………………………………………………………………………………………………………………………….</p> <p align="left"> …………………………………………………………………………………………………………………………………………………………………….</p> <p align="left">Please enclose all relevant certificates</p> </td> </tr> </tbody> <tbody> <tr> <td colspan="13" valign="top"><p> Recommendation (if applicable): It is hereby certified that the applicant has met the relevant Part-66 maintenance knowledge and experience requirements and it is recommended that the competent authority grants or endorses the Part-66 AML.</p> <p> <br/> <br/> </p> <p> Signed: .............................................................. Name: ..................................................................................</p> <p>Position: ........................................................... Date: ....................................................................................</p> </td> </tr> </tbody> </table> EASA Form 19 Issue 5