TY96/97 CS-STAN Installation Guide 10 November 2016
SUP/TY96/004 Issue 1.0
______________________
Trig Avionics Limited Page 7
3.6.1 Form 123 Example
Enter Company name/Logo and address
EASA Form 123 — Standard Change/Standard Repair
(SC/SR) embodiment record
2. SC/SR title & description:
INSTALLATION OF VHF 8.33KHz COM EQUIPMENT
3
.Applicability:
Enter Aircraft Registration, make and model.
4.
List of parts (description/Part-No/Qty):
REMOVED COM p/n xxxx, s/n xxxx VHF COM. (if replacing an existing COM)
FITTED TY96 Kit p/n 01227-00-01, s/n xxxxx VHF 8.33KHz Capable COM
5. Operational limitations/affected aircraft manuals. Copies of these manuals are provided to the
aircraft owner:
TY96 Operation Manual PN 01239-00
6. Documents used for the development and embodiment of this SC/SR:
TY96 VHF Radio Installation Manual PN 01238-00*
TY96 Operation Manual PN 01239-00*
* -Copies of the documents marked with an asterisk are handed to the aircraft owner.
7. Instructions for continuing airworthiness. Copies of these manuals are provided to the aircraft
owner:
TY96 VHF Radio Installation Manual PN 01238-00
9a. ☑This SC complies with the criteria established in 21A.90B(a) and with chapter(s) ..............CS-
001a........ of Certification Specifications CS-STAN.
9b. □ This SR complies with the criteria established in 21A.431B(a) and with
chapter(s)..........NA................ of Certification Specifications CS-STAN.
10. Date of SC/SR embodiment:
Enter date
11. Identification data and signature for the person responsible
for the embodiment of the SC/SR:
Enter Work Pack ID and Signature
12. Signature of the aircraft owner. This signature attests that all relevant documentation is handed
over from the organisation to the aircraft owner, and therefore, the latter becomes aware of any
impact or limitations on operations or additional continuing airworthiness requirements which may
apply to the aircraft due to the embodiment of the change/repair.
Name: Signature: Date:
To Next Page
Loading...
