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Application For Approval of A Maintenance Programme Application For Amendment of A Maintenance Programme (Tick One)

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lnt273

This document is an application form for approval or amendment of an aircraft maintenance programme submitted to the Civil Aviation Authority (CAA) of New Zealand. It requests information about the operator, aircraft, maintenance provider, existing maintenance programme, proposed changes, documentation, and applicant declaration. The CAA will review the application, complete an assessment checklist, and determine whether to approve the maintenance programme within 28 days of receiving the completed application form and necessary documents.

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Application For Approval of A Maintenance Programme Application For Amendment of A Maintenance Programme (Tick One)

Uploaded by

lnt273
102 views4 pages
This document is an application form for approval or amendment of an aircraft maintenance programme submitted to the Civil Aviation Authority (CAA) of New Zealand. It requests information about the operator, aircraft, maintenance provider, existing maintenance programme, proposed changes, documentation, and applicant declaration. The CAA will review the application, complete an assessment checklist, and determine whether to approve the maintenance programme within 28 days of receiving the completed application form and necessary documents.

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maintanance

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24091-02.pdf

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This document is an application form for approval or amendment of an aircraft maintenance programme submitted to the Civil Aviation Authority (CAA) of New Zealand. It requests information about the operator, aircraft, maintenance provider, existing maintenance programme, proposed changes, documentation, and applicant declaration. The CAA will review the application, complete an assessment checklist, and determine whether to approve the maintenance programme within 28 days of receiving the completed application form and necessary documents.

Copyright:

Attribution Non-Commercial (BY-NC)
Download as PDF, TXT or read online from Scribd
Download as pdf or txt
102 views4 pages

Application For Approval of A Maintenance Programme Application For Amendment of A Maintenance Programme (Tick One)

Uploaded by

lnt273
This document is an application form for approval or amendment of an aircraft maintenance programme submitted to the Civil Aviation Authority (CAA) of New Zealand. It requests information about the operator, aircraft, maintenance provider, existing maintenance programme, proposed changes, documentation, and applicant declaration. The CAA will review the application, complete an assessment checklist, and determine whether to approve the maintenance programme within 28 days of receiving the completed application form and necessary documents.

Copyright:

Attribution Non-Commercial (BY-NC)
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Application for Approval of a Maintenance Programme Application for Amendment of a Maintenance Programme (Tick one)

Note: The CAA Standard Rate hourly charge applies. Instructions and advice for completing this Application Form Refer to Advisory Circular AC91-12 and AC119-5 before completing this application. Entries should be typed or printed in block letters. A cover letter should be included giving an explanation of why the application has been made. Full model and component designations are required (refer to the manufacturers data plates). Note: Applicants should clearly understand that unless all the entries on this form are completed accurately and fully, the approval of the Maintenance Programme may be delayed. 1. The charges associated with the approval of the Maintenance Programme will be invoiced to the registered owner of the aircraft described in Section 3. Applications must be submitted to CAA not less than 28 days prior to the date required. Application (To be completed by the operator)

Name of Operator:
Surname Forename(s) Client ID No. (if known)

Address for Service: Civil


Aviation Act, s8, requires applicants to provide an address for service (ie, a physical address) and to promptly notify the Director of any changes.

Tel:

Fax:

Email:

Postal Address:
(If different from Address for Service.)

Tel: Name: Designation: Address: Tel: 2. Maintenance Provider

Fax:

Email:

Person or organisation who can be contacted for further information concerning this application:

Fax:

Email:

Maintenance provider that will conduct maintenance. Client No: Name:

Page 1 of 4

CAA 24091/02 Rev 6 : Nov 2012

3.

Aircraft Description

Aircraft Manufacturer Model Designation Constructors S/N Yes No Registered to operator: Airworthiness Certificate Category Type of Operation Date: Standard TSN: Restricted Type Certificate No.: MCTOW: Registration: ZKCSN: Special

Part 119: Air Transport or Commercial Transport Part 91: Hire or Reward Private R/H

Engine(s) Manufacturer Model Designation(s) P/N Serial Number(s) Total Time/Cycles Overhaul Details Calendar TBO Propeller(s) Manufacturer Model Designation(s) P/N Serial Number(s) Total Time/Cycles Overhaul Details Calendar TBO TSN TSO Due TSN TSO Due

L/H

CSN CSO L/H

TSN TSO Due

CSN CSO R/H

CSN CSO

TSN TSO Due

CSN CSO

Is the aircraft on another operator Operation Specification?

Yes

No

(If yes then previous operator is required to formally request removal from their Operation Specification) Was the aircraft used on Private operations? Yes No

4.

Utilisation & Typical Mission Profile

Please identify the expected planned annual utilisation (hrs/cycles) and the typical mission profile of the aircraft

5.

Maintenance Status

Maintenance status of aircraft prior to commencing new programme, including next checks due, and time to run

Page 2 of 4

CAA 24091/02 Rev 6 : Nov 2012

6.

Programme No Yes Existing Programme Reference & Revision status: Yes No

Existing Programme

Did previous operator have an approved escalation procedure

How will the new programme or change be started? (Bridging inspections)

7.

Documentation

If application is amendment of an existing approved programme identify the changes. (attach additional sheets if required)

If the amendment varies the recommendations of the manufacturers maintenance manual then documented evidence must be provided to show the airworthiness and reliability of the aircraft is not reduced. (attach additional sheets if required)

List STCs and Modifications installed on the aircraft and any supporting ICAs

The following documents are enclosed to support this application:

Applicants Declaration To the best of my knowledge and belief, the particulars enclosed on this application are accurate in every respect and show compliance with Civil Aviation Rules 91.607, 119.63 or 119.111.

Name: ................................................

Signature: ..........................................

Date: .......................

Signed by the Registered Owner or state the capacity of the person signing

Page 3 of 4

CAA 24091/02 Rev 6 : Nov 2012

CAA Use Only

Date received:

........................

Assessment Checklist completed: Programme approved: Yes No

Yes

CAA Approval

Assessed By: Signature:

............................................ ............................................

(Airworthiness Inspector) Date:

........................

Work Request No.:

............................................

(CAA Approval Number)

Page 4 of 4

CAA 24091/02 Rev 6 : Nov 2012

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