A. MANUFACTURER
NAME
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ADDRESS
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B. PRODUCTION BASIS (Check applicable item}
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PRODUCTION CERTIFICATE (Give production cert,i,cate number}
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TYPE CERTIFICATE ONLY
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APPROVED PRODUCTION INSPECTION SYSTEM
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C. GIVE pUANTITY OF CERTIFICATES REQUIRED FOR OPERATING _NEEDS
DATE OF APPLICATION
I NAME ANO TITLE (Print or type}
SIGNATURE
A. DESCRIPTION OF AIRCRAFT
REGISTERED OWNER ·
ADDRESS
BUILDER
(Make}
MODEL
SERIAL NUMBER
REGISTRATION MARK
B. DESCRIPTION OF FLIGHT
CUSTOMER DEMONSTRATION FLIGHTS
D (Check ,f apphcabteJ
FROM-
TO
I- VIA
DEPARTURE DATE
I DURATION
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C. CREW REQUIRED TO OPERATE THE AIRCRAFT ANO ITS EQUIPMENT,
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PILOT
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CO·PILOT
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NAVIGATOR
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OTHER (Specify}
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0. THE AIRCRAFT DOES NOT MEET THE APPLICABLE AIRWORTHINESS REQUIREMENTS AS FOLLOWS:
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E. THE FOLLOWING RESTRICTIONS ARE CONSIDERED NECESSARY FOR SAFE OPERATION (Use attachment 1f necessary}
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F. CERTIFICATION- I hereby cen1ly that I am the registered owner(orhisagent) ol theaircralt described above: that the aircraft is registered with the Federal Av1ahon Administration 1n
accordance
with Section 501 of the Federal Aviation Act of 1958, and applicable Federal Aviation Regulations: and that the aircraft has been inspected and ,s a1rwonhy for the fhght
described.
DATE
I NAME ANO TITLE (Print orrypeJ
I SIGNATURE
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A. Operating L1m1tat1ons and Markings in Compliance with FAR
G. Statement ol Conformity, FAA Form
8130·9 (Attach when required}
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~as Apphcable
91.9
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H. Foreign A1rwonhiness Cen1f1cation for Import Aircraft
-~;; B. Current Operating L1m1ta11ons Attached
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( Attach when required}
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C. Data, Drawings, Photographs, etc. (Attach when required}
I. Previous Airworthiness Cert1f1cate Issued ,n Accordance with
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D. Current Weight and Balance Information Available in Aircraft
FAR
CAR
(Original
Attached}
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E. Ma1or Repair and Allerat1on. FAA Form 337 (Attach when requrredJ
J. Current Airworthiness Cert1f1cate Issued 1n Accordance with
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21.183( c)
F. This Inspection Recorded in A,rcralt Records
FAR
(Copy attached}
tr u.s. Government Printing Office: 1986-491•818JS3357
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