Regulation (EU) 2019/1383
[MEMBER STATE] A Member of the European Union (*)
AIRWORTHINESS REVIEW CERTIFICATE (ARC) ARC reference: ……….
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:
Aircraft manufacturer: ……………………………………………………………………………………………………………………. Manufacturer’s designation: …………………………………………………………………………………………………………… Aircraft registration: ……………………………………………………………………………………………………………………….. Aircraft serial number: ……………………………………………………………………………………………………………………. is considered airworthy at the time of the review.
Date of issue: ...................................................... Date of expiry: …………………………………………………….. Airframe Flight Hours (FH) at date of issue (**): ………………………………………………………………………………. Signed: ................................................................ Authorisation No: ……………………………......................
1st extension: The aircraft has remained in a controlled environment in accordance with point M.A.901 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. Date of issue: ...................................................... Date of expiry: …………………………………………………….. Airframe Flight Hours (FH) at date of issue (**): ………………………………………………………………………………. Signed: ................................................................ Authorisation No: ……………………………...................... Company Name: ................................................. Approval reference: ……………………………………………..
2nd extension: The aircraft has remained in a controlled environment in accordance with point M.A.901 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. Date of issue: ...................................................... Date of expiry: ……………………………………………………. Airframe Flight Hours (FH) at date of issue (**): ……………………………………………………………………………… Signed: ................................................................ Authorisation No: ……………………………..................... Company Name: ................................................. Approval reference: …………………………………………….
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EASA Form 15a Issue 5
(*) Delete for non-EU Member States.
(**) Except for airships.
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