1. Approved Maintenance Organisation Name, Number, Location 2. Reasons for Submission and Address a. Official Name of Approved Maintenance Number: Original Application for Certificate and Rating Organisation: Change in Rating Change in Location or Housing and Facilities b. Location where business is conducted: Change in Ownership Other (Specify) c. Official Mailing Address of Approved Maintenance Organisation (Number, Street, City, State, & Postal Code) d. Doing Business As: 3. Ratings Applied for: Airframe Powerplant Propeller Avionics/ Radio Instrument Class 1 Class 1 Class 1 Class 1 Class 1 Class 2 Class 2 Class 2 Class 2 Class 2 Class 3 Class 3 Class 3 Class 3 Class 4 Class 4 Accessories Limited Accessories Rotor Blades Specialised Service Class 1 Airframe Landing Gear Fabric (List Process Specification(s)) Class 2 Powerplant Floats Emergency Equip. Class 3 Propeller Avionics/radio Non-Dest. Test Instruments Other 4. List of Maintenance Functions contracted to an outside Maintenance Organisation: 5. Applicants Certification Name of Owner (Include name(s) of individual Owner, all partners, or corporation name given the state, province, or country and date of incorporation) I hereby certify that I have been authorised by the approved maintenance organisation identified in Item 1 above to make this application and that statements attached hereto are true and correct to the best of my knowledge. Date: Authorised Signature: AMO ARSC dated 12/98 Page 1of 2 Record of Action For CAA Use Only Approved Maintenance Organisation Inspection For CAA Use Only 6. Remarks (Identify by item number. Include deficiencies found and ratings denied)
1. Approved Maintenance Organisation Name, Number, Location and Address 2. Reasons for Submission a. Official Name of Approved Maintenance Organisation: Number: Original Application for Certificate and Rating Change in Rating Change in Location or Housing and Facilities b. Location where business is conducted: Change in Ownership Other (Specify) c. Official Mailing Address of Approved Maintenance Organisation (Number, Street, City, State, & Postal Code) d. Doing Business As: 3. Ratings Applied for: Airframe Class 1 Class 2 Class 3 Class 4 Powerplant Class 1 Class 2 Class 3 Propeller Class 1 Class 2 Avionics/ Radio Class 1 Class 2 Class 3 Instrument Class 1 Class 2 Class 3 Class 4 Accessories Class 1 Class 2 Class 3 Limited Airframe Powerplant Propeller Instruments Accessories Landing Gear Floats Avionics/radio Rotor Blades Fabric Emergency Equip. Non-Dest. Test Other Specialised Service (List Process Specification(s)) 4. List of Maintenance Functions contracted to an outside Maintenance Organisation: 5. Applicants Certification Name of Owner (Include name(s) of individual Owner, all partners, or corporation name given the state, province, or country and date of incorporation) I hereby certify that I have been authorised by the approved maintenance organisation identified in Item 1 above to make this application and that statements attached hereto are true and correct to the best of my knowledge. Date: Authorised Signature: AMO ARSC dated 12/98 Page 1of 2 For CAA Use Only Record of Action Approved Maintenance Organisation Inspection For CAA Use Only 6. Remarks (Identify by item number. Include deficiencies found and ratings denied)
06_MCAR_Part-6_and_IS_V2.8.docx