Recommendation for issuance of Airworthiness Review Certificate

for Part-M aircrafts

(Based on M.A.904 (b), AMC M.A.901(d), AMC M.A.901(k), AMC M.A.901(l and m), CAMO.A.125(e)(2), CAO.A.095(c))
Aircraft registration

General information
SE-
Owner/lessee

Document review
Date (Start) Date (Completion) Place

-
Aircraft survey
Date (Start) Date (Completion) Place

-
Period and place the aircraft can be seen if required by the Swedish Transport Agency
Date Place

Aircraft information
Type S/N Total time Total cycles

Manufacturer Year of manufacture

Type certificate (TCDS) Type certificate (TCDS) revision date

Flight manual reference (AFM) Flight manual (AFM) revision (No. or date) Date of reference list, AFM

Maintenance programme (AMP) reference AMP revision (No. or date) Date of annual review

Weight and center of gravity data

Weight report date (Grundtomviktsbestämning, datum) Equipment list (Grundspecifikation, datum)

Weight and balance report date Weight change record report

(Vikt- och balansbesked (eller motsvarande), datum) (Tillägg till grundspecifikation, datum)

Document accompanying the recommendation (number the appendices)

Appendix No Sign
Copy of registration papers
(Nationalitets- och registreringsbevis)

Appendix No Sign
Copy of the owners request for a new airworthiness review certificate
(Form L1807-x, "ANSÖKAN OM MILJÖ- OCH LUFTVÄRDIGHETSHANDLINGAR FÖR EASA LUFTFARTYG")

Appendix No Sign
A precise list of the areas of the aircraft that were reviewed and their status

(Copy of the document of review of the aircraft records)

Appendix No Sign
A precise list of the areas of the aircraft that were surveyed and their status

(Copy of the document of physical survey)

Appendix No Sign
A list of all the findings made during the airworthiness review with the corrective action carried out

*¹ Appendix No Sign
List of persons or organisations having carried out continuing airworthiness activities on the aircraft and its
components since the last airworthiness review certificate
(Who have been responsible for the airworthiness. Owner/CAMO/CAO)
*¹ Appendix No Sign
List of persons or organisations having carried out maintenance tasks on the aircraft and its components since the
last airworthiness review certificate
(Pilot/owner, Part-66, Part-M subpart F, Part-145,Part-CAO)
*¹ Not at import into the EU

Postal Adress Visiting Adress Phone Telefax E-mail

Transportstyrelsen Olai Kyrkogata 35 +46 771 503 503 +46 11 415 22 50 arc@transportstyrelsen.se
Sjö- och luftfartsavdelningen Norrköping Org nr
601 73 Norrköping 202100-6099 www.transportstyrelsen.se
Rev 05 2020-03-25 Page 1 of 3
 Aircraft registration

SE-

Statement signed by the airworthiness review staff

Undersigned confirms that the aircraft in its current configuration complies with the information below, and the items should clearly state the exact
reference of the data used in establishing compliance. All of the data below is properly entered and certified in the aircraft continuing airworthiness
record system and/or in the operator’s technical log.

 All airworthiness directives up to the latest published issue. Date ______________________________

The aircraft complies with:

 the type certificate data sheet
 the maintenance programme
 the component service life limitations
 the valid weight and centre of gravity reflecting the current configuration of the aircraft
 Part-21 for all modifications
 Part-21 for all repairs
 the current flight manual including supplements
 the operational requirements: Record
o VFR
o IFR
o VFR night
o RVSM
o Private
o Aerial Work
o Flight Training
o CAT (EASA OPS)
o Other (E.g. B-NAV, P-NAV, RNP, RNAV, MNPS etc)

Approved organisation responsible for the airworthiness (CAMO/CAO) carrying out the airworthiness review
Name Approval reference

Airworthiness review staff authorisation No. Phone number incl country and area code

Airworthiness review staff signature Airworthiness review staff printed name

Place Date

Sign
At import into the EU
Supplementary information on page 3, taken in and enclosed

Additional information enclosed if a non-Swedish CAMO/CAO issue the recommendation

Appendix No Sign
A copy of Approval Certificate and schedule

Appendix No Sign
A copy of CAME/CAE (or equivalent showing) that the Airworthiness Review Staff signing
the recommendation is authorized.

Postal Adress Visiting Adress Phone Telefax E-mail

Transportstyrelsen Olai Kyrkogata 35 +46 771 503 503 +46 11 415 22 50 arc@transportstyrelsen.se
Sjö- och luftfartsavdelningen Norrköping Org nr
601 73 Norrköping 202100-6099 www.transportstyrelsen.se
Rev 05 2020-03-25 Page 2 of 3
At import into the EU shall the recommendation be supplemented with the following aircraft
information:

Aircraft information
Previous registration Aircraft assigned registration
SE-
Export certificate number Noise and emission type certificate number (TCDSN)

State of manufacturer

Document accompanying the recommendation (number the appendices)

Appendix No. Sign
Export certificate (original)
Appendix No. Sign
Copy of the page(s) of the flight manual including possible supplement that contains the document no,
approval, revision no. and Aircraft MSN
Appendix No. Sign
List of airworthiness directives incorporated up to the latest published issue. Date ___________________
Appendix No. Sign
Proposed new maintenance programme
Appendix No. Sign
List of status of all service life limited components
Appendix No. Sign
The valid weight and centre of gravity schedule reflecting the current configuration of the aircraft
Appendix No. Sign
Part-21 approval reference for all modifications (listed)
Appendix No. Sign
Part-21 approval reference for all repairs (listed)
Appendix No. Sign
A copy of the work packages requested by the subpart G organisation including details of any bridging check to
ensure all the necessary maintenance has been carried out
Appendix No. Sign
A copy of the check flight report (if performed).

Postal Adress Visiting Adress Phone Telefax E-mail

Transportstyrelsen Olai Kyrkogata 35 +46 771 503 503 +46 11 415 22 50 arc@transportstyrelsen.se
Sjö- och luftfartsavdelningen Norrköping Org nr
601 73 Norrköping 202100-6099 www.transportstyrelsen.se
Rev 05 2020-03-25 Page 3 of 3