VIETNAM AIRLINES ENGINEERING COMPANY FORM 5001

1. Certificate Ref:
RE-CERTIFIED CERTIFICATE
CHỨNG CHỈ CHO PHÉP SỬ DỤNG THIẾT BỊ HBM.20.1073
Organization approved by the authority to issue this Form: 2. Work Order/ Contract Ref:
VIETNAM AIRLINES ENGINEERING COMPANY
Main Facility: Noi Bai International Airport, Ha Noi, Viet Nam
Satellite Facility: Tan Son Nhat Int’l Airport, Hochiminh city, Viet Nam
3. Item 4. Description 5. Part Number 6. Quantity 7. Serial No./ Batch No.

1 AIR INTAKE COWL 642-1000-505 01 11396001

8. Status/ Work: SERVICEABLE

9. Remarks: ROB FROM A651

10. Statement: Certifies that the work specified in block 8 except as otherwise specified in block 9 was carried out in accordance with the current
regulation of the competent Authority and in respect to that work, the aircraft component is considered ready for release to service.
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11. Approval of competent Authority: CAAV approval No. VN-268/CAAV .....................................................................................................

12. Name 13. Signature 14. Authorization Number 15. Location 16. Date (dd mmm yyyy)

TRAN XUAN HAU HAN 26 FEB 2020

ISS. 02, REV. 04 - DATE: 01 AUG 2015 PAGE: /

 VIETNAM AIRLINES ENGINEERING COMPANY FORM 5001

Form 5001 completion guidance:

Block 1. Enter Certification Number
Block 2. Enter Work order/ contract reference.
Block 3. Enter ordinal number of the component
Block 4. Enter Description of the component
Block 5. Enter Part Number
Block 6. Enter Quantity
Block 7. Enter Serial Number or Batch Number
Block 8. Enter Status/ Work performed.
Block 9. Enter specific condition/ limitation of operating and installation.
Block 10. Mark with a tick in appropriate box to specify the regulations or requirements that the work is performed in accordance with.
Block 11. Tick on appropriate Approval Number of the competent Authority.
Block 12. Enter Name of the person who issues this certificate.
Block 13. Enter Signature of the person who issues this certificate.
Block 14. Enter Authorization number of the person who issues this certificate.
Block 15. Enter IATA code of the station where this certificate is issued. E.g.: HAN for Noi Bai International Airport.
Block 16. Enter date of issuance in the format of dd mmm yyyy. E.g.: 15 JAN 2010.

ISS. 02, REV. 04 - DATE: 01 AUG 2015 PAGE: /