<p> Belgian Civil Aviation Authority</p><p>Part-M Subpart F Approval Initial Application Application for: Part-145 Approval Change Part M Subpart G Approval</p><p>1. Registered name of applicant: To complete a text box, right click the box, choose ‘TextBox Object>Edit’ then type your response.</p><p>2. Trading name (if different): </p><p>3. Address of site(s) requiring approval:</p><p>4. Reference number in the Belgian Crossroads Bank for Enterprises:</p><p>5. Contact Details:</p><p>Tel. Fax</p><p>E-mail(s)</p><p>6. Scope of approval relevant to this application; See page 2 for possibilities in the case of a Subpart-F/Part-145 Approval: </p><p>6. Position and name of the (proposed *) Accountable Manager:</p><p>7. Signature of the (proposed *) Accountable Manager: 8. Place: 9. Date</p><p>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</p><p>* “proposed” applicable only in the case of a new Applicant</p><p>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</p><p>CLASS RATING LIMITATION BASE LINE AIRCRAFT A1 State aeroplane/airship type Aeroplanes/airships above 5700 Kg</p><p>A2 State aeroplane/airship manufacturer or group Aeroplanes/airships or type 5700 Kg and below</p><p>A3 Helicopters State helicopter manufacturer or group or type</p><p>A4 Aircraft other than State aircraft type or group A1, A2 or A3</p><p>ENGINES B1 Turbine State engine type</p><p>B2 Piston State engine manufacturer or group or type</p><p>B3 APU State engine manufacturer or type</p><p>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.</p><p>End of form</p><p>PART M - EASA Form 2 Issue 4 01/04/2016 Page 2/2 LA.T-CAD.01D50</p>