AIESL/FTM/1.

1/B03 Iss 2 Rev 0 CA Form 1 ( For Component Transfer)

2. AUTHORISED RELEASE CERTIFICATE (CA FORM 1) 3. Form Tracking Number-
1. DGCA, INDIA
4. Approved Organisation Name And Address :– Air India Engineering Services Limited (AIESL), 5. Work order/Contract/Invoice
113, Gurudwara Rakabganj Road, New Delhi. (Component Transfer Number)

AIXL/TRV/VTGHK/LM/210
(As referenced in AIESL/FTM 01/1.1/F03 A)
6. Item 7. Description 8. Part Number 9. Qty 10. Serial/Batch 11. Status/Work
No.
LED MODULE 72303187-3 01 N/A INSPECTED
12. Remarks-
This is to certify that the component has been removed from serviceable Aircraft (ARC valid) / Engine ( VT-GHK (RH) / Engine S. No. - N/A ) to install on
Aircraft/ Engine (VT-GHK (LH) / Engine S. No.- N/A ) and meets the following requirements:
a) The last flight of the aircraft with the component fitted reveals no faults on that component/ related system and aircraft is not involved in
accidents, incidents, heavy landing or lightning strikes that could affect the serviceability of the above component.
b) The aircraft component inspected for condition, damage, corrosion or leakage.
c) The maintenance task applicable to the component, if any, as per the scheduled maintenance check of the donor aircraft is performed *
d)
13.a. Certifies that the items Identified above were manufactured in conformity to 14.a. CAR.145.A.50 Release
□ approved design data and are in condition for safe operation X Other regulations specified to service in block 12
□ non approved design data as specified in block 12
X Certifies that unless otherwise specified in block 12 the work
identified in block 11 and described in block 12 was
accomplished in accordance with CAR145 and in respect to that
work the items are considered ready for release to service.
13.b. Authorised Signature 13.c. Approval/Authorisation 14.b Authorised Signature 14.c. Certificate/ Approval
F-APP/AIESL/2820
13.d. Name 13.e. Date 14.d Name and Authorisation No. 14.e. Date
BOBBY V SINGH 16/12/2019
Note:-This certificate does not automatically constitute authority to install. Where the user/installer performs work in accordance with regulations of an airworthiness authority different than the
airworthiness authority specified in block 1, it is essential that the user/installer ensures that his/her airworthiness authority accepts items from the airworthiness authority specified in block 1.
Statements in blocks 13a and 14a do not constitute installation certification. In all cases aircraft maintenance records must contain an installation certification issued in accordance with the
national regulations by the user/installer before the aircraft may be flown
* Certified vide AICL/TRV/EC-05/3004 dated 08 April 2017