EASA Form 15a

• Regulation (EU) 2019/1383 found in: Continuing Airworthiness (1321/2014) Part-M Part-145 Part-66 Part-147 Part-T Part-ML Part-CAMO Part-CAO (Jul 2024)

#### EASA Form 15a Regulation (EU) 2019/1383 <table border="1" cellpadding="0" cellspacing="0"><tr><td valign="top" width="601"><p>[MEMBER STATE]</p><p>A Member of the European Union (*)</p><p>AIRWORTHINESS REVIEW CERTIFICATE (ARC)</p><p>ARC reference: ……….</p><p>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:</p><p>Aircraft manufacturer: …………………………………………………………………………………………………………………….</p><p>Manufacturer’s designation: ……………………………………………………………………………………………………………</p><p>Aircraft registration: ………………………………………………………………………………………………………………………..</p><p>Aircraft serial number: …………………………………………………………………………………………………………………….</p><p>is considered airworthy at the time of the review.</p><p>Date of issue: ...................................................... Date of expiry: ……………………………………………………..</p><p>Airframe Flight Hours (FH) at date of issue (**): ……………………………………………………………………………….</p><p>Signed: ................................................................ Authorisation No: ……………………………......................</p><p>1st extension: The aircraft has remained in a controlled environment in accordance with point <a href="#_DxCrossRefBm1518544877">M.A.901</a> 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 issue.</p><p>Date of issue: ...................................................... Date of expiry: ……………………………………………………..</p><p>Airframe Flight Hours (FH) at date of issue (**): ……………………………………………………………………………….</p><p>Signed: ................................................................ Authorisation No: ……………………………......................</p><p>Company Name: ................................................. Approval reference: ……………………………………………..</p><p>2nd extension: The aircraft has remained in a controlled environment in accordance with point <a href="#_DxCrossRefBm1518544877">M.A.901</a> 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 issue.</p><p>Date of issue: ...................................................... Date of expiry: …………………………………………………….</p><p>Airframe Flight Hours (FH) at date of issue (**): ………………………………………………………………………………</p><p>Signed: ................................................................ Authorisation No: …………………………….....................</p><p>Company Name: ................................................. Approval reference: …………………………………………….</p></td></tr></table> EASA Form 15a Issue 5 (\*) Delete for non-EU Member States. (\*\*) Except for airships. #### EASA Form 15a *Regulation (EU) 2019/1383* <table cellpadding="7" cellspacing="0"> <col/> <tr> <td valign="top"><p align="center"> <br/> </p> <p align="center"> [MEMBER STATE]</p> <p align="center"> A Member of the European Union (*)</p> <p align="center"> <br/> </p> <p align="left"> <b>AIRWORTHINESS REVIEW CERTIFICATE (ARC)</b></p> <p align="center"> ARC reference: ……….</p> <p align="center"> <br/> </p> <p align="left"> 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:</p> <p> <br/> <br/> </p> <p align="left"> Aircraft manufacturer: …………………………………………………………………………………………………………………….</p> <p align="left"> Manufacturer’s designation: ……………………………………………………………………………………………………………</p> <p align="left"> Aircraft registration: ………………………………………………………………………………………………………………………..</p> <p align="left"> Aircraft serial number: …………………………………………………………………………………………………………………….</p> <p align="left"> is considered airworthy at the time of the review.</p> <p align="left"> <br/> </p> <p align="left"> Date of issue: ...................................................... Date of expiry: ……………………………………………………..</p> <p align="left"> Airframe Flight Hours (FH) at date of issue (**): ……………………………………………………………………………….</p> <p align="left"> Signed: ................................................................ Authorisation No: ……………………………......................</p> <p align="left"> <br/> </p> <p align="left"> 1st extension: The aircraft has remained in a controlled environment in accordance with point <u><a href="#_DxCrossRefBm1203439764">M.A.901</a></u> 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 issue.</p> <p align="left"> Date of issue: ...................................................... Date of expiry: ……………………………………………………..</p> <p align="left"> Airframe Flight Hours (FH) at date of issue (**): ……………………………………………………………………………….</p> <p align="left"> Signed: ................................................................ Authorisation No: ……………………………......................</p> <p align="left"> Company Name: ................................................. Approval reference: ……………………………………………..</p> <p align="left"> <br/> </p> <p align="left"> 2nd extension: The aircraft has remained in a controlled environment in accordance with point <u><a href="#_DxCrossRefBm1203439764">M.A.901</a></u> 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 issue.</p> <p align="left"> Date of issue: ...................................................... Date of expiry: …………………………………………………….</p> <p align="left"> Airframe Flight Hours (FH) at date of issue (**): ………………………………………………………………………………</p> <p align="left"> Signed: ................................................................ Authorisation No: …………………………….....................</p> <p align="left"> Company Name: ................................................. Approval reference: …………………………………………….</p> <p align="left"><br/> </p> </td> </tr> </table> EASA Form 15a Issue 5 (\*) Delete for non-EU Member States. (\*\*) Except for airships.