AVIATION SAFETY FORMS MANUAL
Doc Ref: AS/FM/01
SECTION:
AIRWORTHINESS FORMS
CERTIFICATE OF AIRWORTHINESS (FOR EXPORT) –
ISSUANCE APPLICATION
AWF-COA-003
TITLE:
AIRWORTHINESS REVIEW CERTIFICATE (ARC) –
ISSUANCE/RECOMMENDATION/ENDORSEMENT APPLICATION
DETAILS
1. Check list for:
Initial C of A Issuance
ARC Issuance
Registration Mark:
2. Aircraft Details
CHECKED BY
Export C of A Issuance
ARC Recommendation/Endorsement
Sign/Stamp
a) Type:
b) Contracted Maintenance
Organization (Approval No.):
c) Registration:
d) Registered Owner/Operator:
e) Manufacture Serial Number
(MSN):
f) Year Built:
g) Type Data Sheet No./Rev:
h) Type Certificate Number and
Issuing Authority:
i.
Airframe:
ii.
Engine:
iii.
Propeller:
i) Export Certificate of Airworthiness
(if applicable):
j) Date of Issue:
k) Issuing Authority:
l)
Category:
m) Derogations/Limitations:
n) Maximum Total Mass Allowed:
o) Certificate of Airworthiness No.:
Date: 20 February 2014
Revision: 6
Page 1 of 7
AVIATION SAFETY FORMS MANUAL
Doc Ref: AS/FM/01
SECTION:
AIRWORTHINESS FORMS
CERTIFICATE OF AIRWORTHINESS (FOR EXPORT) –
ISSUANCE APPLICATION
AWF-COA-003
TITLE:
AIRWORTHINESS REVIEW CERTIFICATE (ARC) –
ISSUANCE/RECOMMENDATION/ENDORSEMENT APPLICATION
p) Airworthiness Review Certificate
No.:
q) Category:
3. Aircraft Hours and Cycles/Landings
a) Date prior to this renewal (D/M/Y):
b) Total hours:
c) Total Cycles/Landings:
d) Total Cycles/Hours since last
renewal:
4. Engine Details
Type:
Serial No.
Position:
TSO
hrs
TBO
cycles
hrs
cycles
Engine 1
Engine 2
Engine 3
Engine 4
Note: A copy of the release form to be provided for every engine.
5. APU Details
Type:
Serial No.
TSO (hrs/cycles)
TBO (hrs/cycles)
Note: A copy of the release form to be provided for the APU.
6. Propeller Details
Propeller Type:
Position:
Serial No.
Engine 1
TSO (hrs/cycles)
TBO (hrs/cycles)
Engine 2
Date: 20 February 2014
Revision: 6
Page 2 of 7
AVIATION SAFETY FORMS MANUAL
Doc Ref: AS/FM/01
SECTION:
AIRWORTHINESS FORMS
CERTIFICATE OF AIRWORTHINESS (FOR EXPORT) –
ISSUANCE APPLICATION
AWF-COA-003
TITLE:
AIRWORTHINESS REVIEW CERTIFICATE (ARC) –
ISSUANCE/RECOMMENDATION/ENDORSEMENT APPLICATION
Engine 3
Engine 4
Note: A copy of the release form to be provided for every propeller.
7. Documentation Audit
The following have been checked and found to be in compliance with the existing requirement:
Aircraft Technical Log Check:
a) Hours/cycles are being correctly added
Yes
No
b) Defect Recording/Deferment/Certification
Yes
No
c) Control of Acceptable Deferred Defects satisfactory
Yes
No
d) Log sheets for completeness
Yes
No
e) Maintenance certified (CRS)
Yes
No
f)
Number of Concessions/Dispensations issued since
the last C of A (Attach copies)?
g) All Concessions/Dispensations were issued/actioned/
approved in a manner approved by the GCAA.
Flight Manual Check:
a) Last revision number and date (D/M/Y):
Yes
No
N/A
b) Aircraft existing revision No. and date (D/M/Y)
Number of Flight Manual Supplements issued since last C
of A
Mandatory Data Compliance Check:
a) Ensure all Mandatory requirements are complied with
as per the latest standard
b) GCAA Airworthiness requirements complied with
Others:
Yes
No
Yes
No
This aircraft and all associated engines/components are in compliance with all applicable ADs and
mandatory requirements by the State of design up to and including the date indicated below.
FAA Biweekly
EASA AD Biweekly
date:
date:
Note: A detailed AD Compliance report data shall be provided, which list all ADs issued for this aircraft
indicating applicability and means of compliance and date complied with.
Date: 20 February 2014
Revision: 6
Page 3 of 7
AVIATION SAFETY FORMS MANUAL
Doc Ref: AS/FM/01
SECTION:
AIRWORTHINESS FORMS
CERTIFICATE OF AIRWORTHINESS (FOR EXPORT) –
ISSUANCE APPLICATION
AWF-COA-003
TITLE:
AIRWORTHINESS REVIEW CERTIFICATE (ARC) –
ISSUANCE/RECOMMENDATION/ENDORSEMENT APPLICATION
Documents – Check condition and presence and completion of:
ARC
Certificate of Registration
Expiry date:
Radio License
Technical Log
Expiry date:
Insurance Certificate
Aircraft & Engine log books
Expiry date:
Current Mass date:
Effective Compass Swing Check
date:
Next Mass
Schedule date:
MMEL/MEL
Current aircraft MEL complies with the latest MMEL requirement:
Yes
No
Latest MMEL Rev. No:
Rev. Dated
8. Mode S Code
Mode S Code (Hexadecimal)
Installed
This is applicable for C of A issuance
Removed This is applicable for C of A for Export
Changed
This is applicable for change of aircraft ownership
9. Flight Test
Required by GCAA:
Yes
No
Date Carried out to:
GCAA Approved Flight Test Schedule
Rev. No:
Date:
10. Maintenance
GCAA AMP Rev. No:
Date:
The AMP was reviewed and found in compliance with the latest manufacturer approved data.
Schedule Compliance Check:
a) Schedule Inspections since ARC Issue/Recommendation
b) A list is to be provided indicating the maintenance performed and next due check
Significant Repairs, Replacement, Defects, Modification since ARC Issuance/Recommendation
Corrosion Prevention Control Program:
a) Inspection availability
Yes
No
b) CPCP Complied with
Yes
No
Number of Findings:
Level 1
Level 2
Level 3
Inspection Details:
Check the following and provide details of compliance where indicated:
Out of Phase maintenance items – Hrs/Ldgs/Calendar
(Compliance record required)
Structural Inspections and Lifted Items
Date: 20 February 2014
Revision: 6
Page 4 of 7
AVIATION SAFETY FORMS MANUAL
Doc Ref: AS/FM/01
SECTION:
AIRWORTHINESS FORMS
CERTIFICATE OF AIRWORTHINESS (FOR EXPORT) –
ISSUANCE APPLICATION
AWF-COA-003
TITLE:
AIRWORTHINESS REVIEW CERTIFICATE (ARC) –
ISSUANCE/RECOMMENDATION/ENDORSEMENT APPLICATION
(Compliance record required)
Compliance with CPCP Programme (detailed report to be provided)
(Compliance record required)
Technical Records accurate
Manufacturers Bulletins reviewed
Variations to Maintenance intervals & dates approximately approved
(Compliance record required)
Airframe, Engine, Propeller, Modification, Log Books for Completeness
Modifications, Repairs, STCs certified
(Compliance record required)
11. Airworthiness Physical Inspection Audit
Aircraft Condition Inspection Check
Condition/Cleanliness in LG. Bays/Landing Gear
Power Plant
Control Surfaces
Controls
Rotors
Registration Mark
Emergency Mark
Exterior - General Condition Check:
Damage Marking (Check against damage chart, tech log)
Condition/Cleanliness in LG. Bays/Landing Gear
Engine Intakes /Engines
Fan Blades/Propellers/Rotors
Interiors
Doors/Surrounds
Wings
Cockpit
Consoles
Floors
Compass Correction cards
Windscreen & Windows
Placards (Ref. Flight manual & Maintenance Manual)
Seats
Seat Harness Condition
Spare Bulbs/Filaments
Aircraft document library for condition & completion
In addition, the person issuing this recommendation is required to perform a physical inspection of
the aircraft to ensure continued Airworthiness of the aircraft and compliance with GCAA existing
requirements.
Note: This inspection shall be performed with aircraft doors opened including landing gear doors. Panels
and side walls doors are not normally required to be opened for this inspection, unless required for further
investigation or specifically requested.
Date: 20 February 2014
Revision: 6
Page 5 of 7
AVIATION SAFETY FORMS MANUAL
Doc Ref: AS/FM/01
SECTION:
AIRWORTHINESS FORMS
CERTIFICATE OF AIRWORTHINESS (FOR EXPORT) –
ISSUANCE APPLICATION
AWF-COA-003
TITLE:
AIRWORTHINESS REVIEW CERTIFICATE (ARC) –
ISSUANCE/RECOMMENDATION/ENDORSEMENT APPLICATION
12. Findings
List (or attach to this report) any comments concerning, discrepancies, overruns,
irregularities, matters of significance, or corrective actions, noted during or
raised as a result of this inspection.
Use additional sheets if required
Number of additional sheets raised
Yes
No
13. Continued Airworthiness – Maintenance Support:
The operator has UAE AMO capability for the maintenance of this aircraft
Yes
No
The operator has a contract with UAE AMO for the maintenance of this aircraft
Yes
No
AMO approval Number:
Note: Copy of the contract has to be provided.
14. Waivers (If any):
15. Declaration
I hereby under the privileges granted by UAE GCAA approval Ref. __________,
declare this aircraft airworthy as defined by UAE GCAA CARs, except for findings
as listed in item 11 above, and provided that the necessary corrective actions
have been taken and accepted by the under signed.
Name:
Signature:
Date:
Authority/Stamp:
Note:
1) The mentioned documents and publications should be made available for
assessment at the time of the survey.
2) The applicant must complete, sign and stamp item 1 up to and item 14 and
ensure all the documents are made available for the Airworthiness Inspector.
3) The inspector might require certain panels to be removed to facilitate the
survey.
Date: 20 February 2014
Revision: 6
Page 6 of 7
AVIATION SAFETY FORMS MANUAL
Doc Ref: AS/FM/01
SECTION:
AIRWORTHINESS FORMS
CERTIFICATE OF AIRWORTHINESS (FOR EXPORT) –
ISSUANCE APPLICATION
AWF-COA-003
TITLE:
AIRWORTHINESS REVIEW CERTIFICATE (ARC) –
ISSUANCE/RECOMMENDATION/ENDORSEMENT APPLICATION
FOR GCAA USE ONLY
Aircraft Registration Mark:
Issued Date:
____/____/____
Day Month Year
ARC Expiry Date:
____/____/____
Day Month Year
Name:
Date:
Date: 20 February 2014
Revision: 6
Page 7 of 7