Belgian Civil Aviation Authority

Part-M Subpart F Approval Initial Application Application for: Part-145 Approval Change Part M Subpart G Approval

1. Registered name of applicant: To complete a text box, right click the box, choose ‘TextBox Object>Edit’ then type your response.

2. Trading name (if different):

3. Address of site(s) requiring approval:

4. Reference number in the Belgian Crossroads Bank for Enterprises:

5. Contact Details:

Tel. Fax

E-mail(s)

6. Scope of approval relevant to this application; See page 2 for possibilities in the case of a Subpart-F/Part-145 Approval:

6. Position and name of the (proposed *) Accountable Manager:

7. Signature of the (proposed *) Accountable Manager: 8. Place: 9. Date

Directoraat-Generaal Luchtvaart Direction Générale Transport Aérien Directie Techniek Direction Technique Dienst Bedrijfserkenningen Service Agréation des entreprises Vooruitgangstraat 56 Rue du Progrès 56 1210 Brussel 1210 Bruxelles

* “proposed” applicable only in the case of a new Applicant

PART M - EASA Form 2 Issue 4 01/04/2016 Page 1/2 LA.T-CAD.01D50 SCOPE OF REQUESTED PART M SUBPART-F / PART-145 APPROVAL

CLASS RATING LIMITATION BASE LINE AIRCRAFT A1 State aeroplane/airship type Aeroplanes/airships above 5700 Kg

A2 State aeroplane/airship manufacturer or group Aeroplanes/airships or type 5700 Kg and below

A3 Helicopters State helicopter manufacturer or group or type

A4 Aircraft other than State aircraft type or group A1, A2 or A3

ENGINES B1 Turbine State engine type

B2 Piston State engine manufacturer or group or type

B3 APU State engine manufacturer or type

COMPONENTS C1 Air Cond & Press State aircraft type or aircraft manufacturer or OTHER THAN C2 Auto Flight component manufacturer or the particular component C3 Comms and Nav and or cross refer to a capability list in the exposition and/or COMPLETE C4 Doors – Hatches maintenance task(s). ENGINES OR C5 Electrical Power & APUs Lights C6 Equipment C7 Engine – APU C8 Flight Controls C9 Fuel C10 Helicopter – Rotors C11 Helicopter – Trans C12 Hydraulic Power C13 Indicating/ recording system C14 Landing Gear C15 Oxygen C16 Propellers C17 Pneumatic & Vacuum C18 Protection ice/rain/fire C19 Windows C20 Structural C21 Water ballast C22 Propulsion Augmentation SPECIALISED D1 Non Destructive State particular NDT methods SERVICES Testing.

End of form

PART M - EASA Form 2 Issue 4 01/04/2016 Page 2/2 LA.T-CAD.01D50