‘Appendix I

Authorised Release Certificate — EASA Form 1 referred to in the Annex (Part 21)

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Instructions for the use of EASA Form 1

These instructions relate only to the use of the EASA Form 1 for production purposes. Attention is drawn to Appendix II to Annex I (Part M) of Regulation (EC) No 2042/2003 which covers the use of the EASA Form 1 for maintenance purposes.

1.   PURPOSE AND USE

1.1.

A primary purpose of the certificate is to declare the airworthiness of new aviation products, parts and appliances (hereafter referred to as “item(s)”).

1.2.

Correlation must be established between the certificate and the item(s). The originator must retain a certificate in a form that allows verification of the original data.

1.3.

The certificate is acceptable to many airworthiness authorities, but may be dependent on bilateral agreements and/or the policy of the airworthiness authority. The “approved design data” mentioned in this certificate then means approved by the airworthiness authority of the importing country.

1.4.

The certificate is not a delivery or shipping note.

1.5.

Aircraft are not to be released using the certificate.

1.6.

The certificate does not constitute approval to install the item on a particular aircraft, engine, or propeller but helps the end user determine its airworthiness approval status.

1.7.

A mixture of production released and maintenance released items is not permitted on the same certificate.

1.8.

A mixture of items certified in conformity with “approved data” and to “non-approved data” is not permitted on the same certificate.

2.   GENERAL FORMAT

2.1.

The certificate must comply with the format attached including block numbers and the location of each block. The size of each block may however be varied to suit the individual application, but not to the extent that would make the certificate unrecognisable.

2.2.

The certificate must be in “landscape” format but the overall size may be significantly increased or decreased so long as the certificate remains recognisable and legible. If in doubt consult the competent authority.

2.3.

The User/Installer responsibility statement can be placed on either side of the form.

2.4.

All printing must be clear and legible to permit easy reading.

2.5.

The certificate may either be pre-printed or computer generated but in either case the printing of lines and characters must be clear and legible and in accordance with the defined format.

2.6.

The certificate should be in English, and if appropriate, in one or more other languages.

2.7.

The details to be entered on the certificate may be either machine/computer printed or hand-written using block letters and must permit easy reading.

2.8.

Limit the use of abbreviations to a minimum, to aid clarity.

2.9.

The space remaining on the reverse side of the certificate may be used by the originator for any additional information but must not include any certification statement. Any use of the reverse side of the certificate must be referenced in the appropriate block on the front side of the certificate.

3.   COPIES

3.1.

There is no restriction in the number of copies of the certificate sent to the customer or retained by the originator.

4.   ERROR(S) ON A CERTIFICATE

4.1.

If an end-user finds an error(s) on a certificate, he must identify it/them in writing to the originator. The originator may issue a new certificate if they can verify and correct the error(s).

4.2.

The new certificate must have a new tracking number, signature and date.

4.3.

The request for a new certificate may be honoured without re-verification of the item(s) condition. The new certificate is not a statement of current condition and should refer to the previous certificate in block 12 by the following statement: “This certificate corrects the error(s) in block(s) [enter block(s) corrected] of the certificate [enter original tracking number] dated [enter original issuance date] and does not cover conformity/condition/release to service”. Both certificates should be retained according to the retention period associated with the first.

5.   COMPLETION OF THE CERTIFICATE BY THE ORIGINATOR

Block 1 Approving competent authority/Country

State the name and country of the competent authority under whose jurisdiction this certificate is issued. When the Competent Authority is the Agency, only “EASA” must be stated.

Block 2 EASA Form 1 header

Block 3 Form Tracking Number

Enter the unique number established by the numbering system/procedure of the organisation identified in block 4; this may include alpha/numeric characters.

Block 4 Organisation Name and Address

Enter the full name and address of the production organisation (refer to EASA Form 55 Sheet A) releasing the item(s) covered by this certificate. Logos etc. of the organisation are permitted if they can be contained within the block.

Block 5 Work Order/Contract/Invoice

To facilitate customer traceability of the item(s), enter the work order number, contract number, invoice number, or similar reference number.

Block 6 Item

Enter line item numbers when there is more than one line item. This block permits easy cross-referencing to the Remarks block 12.

Block 7 Description

Enter the name or description of the item. Preference should be given to the term used in the instructions for continued airworthiness or maintenance data (e.g. Illustrated Parts Catalogue, Aircraft Maintenance Manual, Service Bulletin, Component Maintenance Manual).

Block 8 Part Number

Enter the part number as it appears on the item or tag/packaging. In case of an engine or propeller the type designation may be used.

Block 9 Quantity

State the quantity of items.

Block 10 Serial Number

If the item is required by regulation to be identified with a serial number, enter it here. Additionally, any other serial number not required by regulation may also be entered. If there is no serial number identified on the item, enter “N/A”.

Block 11 Status/Work

Enter either “PROTOTYPE” or “NEW”.

Enter “PROTOTYPE” for:

(i)	The production of a new item in conformity with non-approved design data.

(ii)

Re-certification by the organisation identified in block 4 of the previous certificate after alteration or rectification work on an item, prior to entry into service, (e.g. after incorporation of a design change, correction of a defect, inspection or test, or renewal of shelf-life.) Details of the original release and the alteration or rectification work are to be entered in block 12.

Enter “NEW” for:

(i)	The production of a new item in conformity with the approved design data.

(ii)

Re-certification by the organisation identified in block 4 of the previous certificate after alteration or rectification work on an item, prior to entry into service, (e.g. after incorporation of a design change, correction of a defect, inspection or test, or renewal of shelf-life.) Details of the original release and the alteration or rectification work are to be entered in block 12.

(iii)

Re-certification by the product manufacturer or the organisation identified in block 4 of the previous certificate of items from “prototype” (conformity only to non-approved data) to “new” (conformity to approved data and in a condition for safe operation), subsequent to approval of the applicable design data, provided that the design data has not changed. The following statement must be entered in block 12: RE-CERTIFICATION OF ITEMS FROM “PROTOTYPE” TO “NEW”: THIS DOCUMENT CERTIFIES THE APPROVAL OF THE DESIGN DATA [INSERT TC/STC NUMBER, REVISION LEVEL], DATED [INSERT DATE IF NECESSARY FOR IDENTIFICATION OF REVISION STATUS], TO WHICH THIS ITEM (THESE ITEMS) WAS (WERE) MANUFACTURED. The box “approved design data and are in a condition for safe operation” should be marked in block 13a.

(iv)

The examination of a previously released new item prior to entry into service in accordance with a customer-specified standard or specification (details of which and of the original release are to be entered in block 12) or to establish airworthiness (an explanation of the basis of release and details of the original release are to be entered in block 12).

Block 12 Remarks

Describe the work identified in block 11, either directly or by reference to supporting documentation, necessary for the user or installer to determine the airworthiness of item(s) in relation to the work being certified. If necessary, a separate sheet may be used and referenced from the EASA Form 1. Each statement must clearly identify which item(s) in block 6 it relates to. If there is no statement, state “None”.

Enter the justification for release to non-approved design data in block 12 (e.g. pending type-certificate, for test only, pending approved data).

If printing the data from an electronic EASA Form 1 any data not appropriate in other blocks should be entered in this block.

Block 13a

Mark only one of the two boxes:

1.	Mark the ‘approved design data and are in a condition for safe operation’ box if the item(s) were manufactured using approved design data and found to be in a condition for safe operation.

2.	Mark the ‘non-approved design data specified in block 12’ box if the item(s) were manufactured using applicable non-approved design data. Identify the data in block 12 (e.g. pending type-certificate, for test only, pending approved data).

Mixtures of items released against approved and non-approved design data are not permitted on the same certificate.

Block 13b Authorised Signature

This space shall be completed with the signature of the authorised person. Only persons specifically authorised under the rules and policies of the competent authority are permitted to sign this block. To aid recognition, a unique number identifying the authorised person may be added.

Block 13c Approval/Authorisation Number

Enter the approval/authorisation number/reference. This number or reference is issued by the competent authority.

Block 13d Name

Enter the name of the person signing block 13b in a legible form.

Block 13e Date

Enter the date on which block 13b is signed, the date must be in the format dd = 2 digit day, mmm = first 3 letters of the month, yyyy = 4 digit year.

Block 14a-14e

General Requirements for blocks 14a-14e:

Not used for production release. Shade, darken, or otherwise mark to preclude inadvertent or unauthorised use.

User/Installer Responsibilities

Place the following statement on the certificate to notify end users that they are not relieved of their responsibilities concerning installation and use of any item accompanied by the form:

‘Appendix II

Airworthiness Review Certificate — EASA Form 15a

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‘Appendix IV

Restricted Certificate of Airworthiness — EASA Form 24

Competent authority LOGO

RESTRICTED CERTIFICATE OF AIRWORTHINESS

(*1)	[Member State of registry] [COMPETENT AUTHORITY OF THE MEMBER STATE]	(*1)
1. Nationality and registration marks	2. Manufacturer and manufacturer’s designation of aircraft	3. Aircraft serial number
4. Categories
5. This Certificate of Airworthiness is issued pursuant to (*2) [the Convention on International Civil Aviation dated 7 December 1944] and Regulation (EC) No 216/2008, Article 5(4)(b) in respect of the abovementioned aircraft which is considered to be airworthy when maintained and operated in accordance with the foregoing and the pertinent operating limitations. In addition to above the following restrictions apply:  (*1)  (*2) [The aircraft may be used in international navigation notwithstanding above restrictions].   Date of issue:   Signature:
6. This Restricted Certificate of Airworthiness is valid unless revoked by the competent authority of the Member State of registry. A current Airworthiness Review Certificate shall be attached to this certificate.

EASA Form 24 Issue 2.

This certificate shall be carried on board during all flights

‘Appendix V

Certificate of Airworthiness — EASA Form 25

Competent authority LOGO

CERTIFICATE OF AIRWORTHINESS

(*3)	[Member State of registry] [COMPETENT AUTHORITY OF THE MEMBER STATE]	(*3)
1. Nationality and registration marks	2. Manufacturer and manufacturer’s designation of aircraft	3. Aircraft serial number
4. Categories
5. This Certificate of Airworthiness is issued pursuant to the Convention on International Civil Aviation dated 7 December 1944 and Regulation (EC) No 216/2008, Article 5(2)(c) in respect of the abovementioned aircraft which is considered to be airworthy when maintained and operated in accordance with the foregoing and the pertinent operating limitations. Limitations/Remark:  (*3)   Date of issue:   Signature:
6. This Certificate of Airworthiness is valid unless revoked by the competent authority of the Member State of registry. A current Airworthiness Review Certificate shall be attached to this certificate.

EASA Form 25 Issue 2.

This certificate shall be carried on board during all flights

‘Appendix VII

Aircraft statement of conformity — EASA Form 52

AIRCRAFT STATEMENT OF CONFORMITY
1. State of manufacture	2. [MEMBER STATE] (*4) A Member of the European Union (*5)		3. Statement Ref No:
4. Organisation
5. Aircraft Type		6. Type-certificate Refs:
7. Aircraft Registration Or Mark		8. Manufacturers Identification No
9. Engine/Propeller Details (*6)
10. Modifications and/or Service Bulletins (*6)
11. Airworthiness Directives
12. Concessions
13. Exemptions, Waivers or Derogations (*6)
14. Remarks
15. Certificate of Airworthiness
16. Additional Requirements
17. Statement of Conformity It is hereby certified that this aircraft confirms fully to the type-certificated design and to the items above in boxes 9, 10, 11, 12 and 13. The aircraft is in a condition for safe operation. The aircraft has been satisfactorily tested in flight.
18. Signed	19. Name		20. Date (d/m/y)
21. Production Organisation Approval Reference

EASA Form 52 Issue 2.

Instructions for the use of the Aircraft Statement of Conformity EASA Form 52

1.   PURPOSE AND SCOPE

1.1.

Use of the aircraft Statement of Conformity issued by a manufacturer producing under Part 21 Section A Subpart F is described under 21A.130 and the corresponding acceptable means of compliance.

1.2.

The purpose of the aircraft Statement of Conformity (EASA Form 52) issued under Part 21 Section A Subpart G is to enable the holder of an appropriate production organisation approval to exercise the privilege to obtain an individual aircraft certificate of airworthiness from the competent authority of the Member State of registry.

2.   GENERAL

2.1.

The Statement of Conformity must comply with the format attached including block numbers and the location of each block. The size of each block may however be varied to suit the individual application, but not to the extent that would make the Statement of Conformity unrecognisable. If in doubt consult the competent authority.

2.2.

The Statement of Conformity must either be pre-printed or computer generated but in either case the printing of lines and characters must be clear and legible. Pre-printed wording is permitted in accordance with the attached model but no other certification statements are permitted.

2.3.

Completion may be either machine/computer printed or hand-written using block letters to permit easy reading. English, and where relevant, one or more of the official language(s) of the issuing Member State are acceptable.

2.4.

A copy of the Statement and all referenced attachments are to be retained by the approved production organisation.

3.   COMPLETION OF THE STATEMENT OF CONFORMITY BY THE ORIGINATOR

3.1.

There should be an entry in all blocks to make the document a valid statement.

3.2.

A Statement of Conformity may not be issued to the competent authority of the Member State of registry unless the design of the aircraft and its installed products are approved.

3.3.

The information required in blocks 9, 10, 11, 12, 13 and 14 may be by reference to separate identified documents held on file by the production organisation, unless the competent authority agrees otherwise.

3.4.

This Statement of Conformity is not intended to include those items of equipment that may be required to be fitted in order to satisfy applicable operational rules. However, some of these individual items may be included in block 10 or in the approved type design. Operators are therefore reminded of their responsibility to ensure compliance with the applicable operational rules for their own particular operation.

Block 1

Enter name of the State of manufacture.

Block 2

The competent authority under which authority the Statement of Conformity is issued.

Block 3

A unique serial number should be pre-printed in this block for statement control and traceability purposes. Except that in the case of a computer generated document the number need not be pre-printed where the computer is programmed to produce and print a unique number.

Block 4

The full name and location address of the organisation issuing the statement. This block may be pre-printed. Logos etc. are permitted if the logo can be contained within the block.

Block 5

The aircraft type in full as defined in the type-certificate and its associated data sheet.

Block 6

The type-certificate reference numbers and issue for the subject aircraft.

Block 7

If the aircraft is registered then this mark will be the registration mark. If the aircraft is not registered then this will be such a mark that is accepted by the competent authority of the Member State and, if applicable, by the competent authority of a third country.

Block 8

The identification number assigned by the manufacturer for control and traceability and product support. This is sometimes referred to as a Manufacturers Serial No or Constructors No.

Block 9

The engine and propeller type(s) in full as defined in the relevant type-certificate and its associated data sheet. Their manufacturer identification No and associated location should also be shown.

Block 10

Approved design changes to the aircraft definition.

Block 11

A listing of all applicable airworthiness directives (or equivalent) and a declaration of compliance, together with a description of the method of compliance on the subject individual aircraft including products and installed parts, appliances and equipment. Any future compliance requirement time should be shown.

Block 12

Approved unintentional deviation to the approved type design sometimes referred to as concessions, divergences, or non-conformances.

Block 13

Only agreed exemptions, waivers or derogations may be included here.

Block 14

Remarks. Any statement, information, particular data or limitation which may affect the airworthiness of the aircraft. If there is no such information or data, state; “NONE”.

Block 15

Enter “Certificate of Airworthiness”, or “Restricted Certificate of Airworthiness”, or for the Certificate of Airworthiness requested.

Block 16

Additional requirements such as those notified by an importing country should be noted in this block.

Block 17

Validity of the Statement of Conformity is dependent on full completion of all blocks on the form. A copy of the flight test report together with any recorded defects and rectification details should be kept on file by the POA holder. The report should be signed as satisfactory by the appropriate certifying staff and a flight crew member, e.g. test pilot or flight test engineer. The flight tests performed are those defined under the control of the quality system, as established by 21A.139 in particular 21A.139(b)(1)(vi), to ensure that the aircraft conforms with the applicable design data and is in condition for safe operation.

The listing of items provided (or made available) to satisfy the safe operation aspects of this statement should be kept on file by the POA holder.

Block 18

The Statement of Conformity may be signed by the person authorised to do so by the production approval holder in accordance with 21A.145(d). A rubber stamp signature should not be used.

Block 19

The name of the person signing the certificate should be typed or printed in a legible form.

Block 20

The date the Statement of Conformity is signed should be given.

Block 21

The competent authority approval reference should be quoted.’;

‘Appendix IX

Production Organisation Approval Certificates referred to in Subpart G of the Annex (Part 21) — EASA Form 55

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‘Appendix X

Letter of agreement — EASA Form 65 — referred to in Subpart F of the Annex (Part 21)

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