Bijlage 1 Regeling afgifte type-certificaten luchtvaartuigen 1996: application form for a dutch type certificate

Regeling afgifte type-certificaten luchtvaartuigen 1996

This form is to be completed by the applicant for a Netherlands Type Certificate or for an amendment of a Netherlands Type Certificate (put a cross in the relevant section). Where the space provided on the form is insufficient, the required information should be given on a separate page attached to this form. This form should be sent to the Aeronautical Inspection Directorate, P.O. Box 575, 2130 AN, Hoofddorp, The Netherlands. 1. Applicant: ... Address: ... Telephone: ... Telefax: ... Telex: ... 2. The applicant requests: O Issue of a type certificate O Amendment of a type certificate 3. Manufacturer, type and model: ‐ Maximum permissible mass: ... kg 4. Original Type Certificate: Number: ... Date of application: ... Issued by: ... Date of issue: ... 5. Category of certificate of airworthiness in which the aircraft affected will be eligible for certification: Date:... Signature of the applicant: ...