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[MEMBER STATE (*)]

A Member of the European Union (**)

MAINTENANCE ORGANISATION CERTIFICATE

Reference: [MEMBER STATE CODE(*)].145.XXXX

Pursuant to Regulation (EU) 2018/1139 of the European Parliament and of the Council and to Commission Regulation (EU) No 1321/2014 and subject to the conditions specified below, the [COMPETENT AUTHORITY OF THE MEMBER STATE (*)] hereby certifies:

[COMPANY NAME AND ADDRESS]

as a maintenance organisation in compliance with Section A of Annex II (Part-145) to Regulation (EU) No 1321/2014, approved to maintain products, parts and appliances listed in the attached terms of approval and issue related certificates of release to service using the above references and, when stipulated, to issue airworthiness review certificates after an airworthiness review as specified in point ML.A.903 of Annex Vb (Part-ML) to that Regulation for those aircraft listed in the attached terms of approval

CONDITIONS:

1.          This approval is limited to that specified in the scope of work section of the approved maintenance organisation exposition as referred to in Section A of Annex II (Part-145), and

2.          This approval requires compliance with the procedures specified in the approved maintenance organisation exposition, and

3.          This approval is valid whilst the approved maintenance organisation remains in compliance with Annex II (Part-145) of Regulation (EU) No 1321/2014.

4.          Subject to compliance with the foregoing conditions, this approval shall remain valid for an unlimited duration unless the approval has previously been surrendered, superseded, suspended or revoked.

Date of original issue: .........................................................................................................................................

Date of this revision: .….......................................................................................................................................

Revision No: ........................................................................................................................................................

Signed: ................................................................................................................................................................

For the competent authority: [COMPETENT AUTHORITY OF THE MEMBER STATE(*)]

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MAINTENANCE ORGANISATION

TERMS OF APPROVAL

Reference: [MEMBER STATE CODE (*)].145.[XXXX]

Organisation: [COMPANY NAME AND ADDRESS]

CLASS

RATING

LIMITATION

BASE

LINE

AIRCRAFT (**)

(***)

(****)

[YES/NO] (**)

[YES/NO] (**)

(***)

(****)

[YES/NO] (**)

[YES/NO] (**)

(***)

(****)

[YES/NO] (**)

[YES/NO] (**)

(***)

(****)

[YES/NO] (**)

[YES/NO] (**)

ENGINES (**)

(***)

(***)

(***)

(***)

COMPONENTS OTHER THAN COMPLETE ENGINES OR APUs (**)

(***)

(***)

(***)

(***)

(***)

(***)

(***)

(***)

(***)

(***)

(***)

(***)

SPECIALISED SERVICES (**)

(***)

(***)

(***)

(***)

These terms of approval are limited to those products, parts and appliances and to the activities specified in the scope of work section of the approved maintenance organisation exposition,

Maintenance Organisation Exposition reference: .............................................................................................

Date of original issue: ........................................................................................................................................

Date of last revision approved: ................................................ Revision No: ………………...................................

Signed: ...............................................................................................................................................................

For the competent authority: [COMPETENT AUTHORITY OF THE MEMBER STATE (*)]