gaca_gov_sa · form · processed · 2 chunks
GACA ال necesita للطيران المدني General Authority of Civil Aviation [Non-Text] MAJOR REPAIR AND ALTERATION (AIRFRAME, POWERPLANT, PROPELLER OR APPLIANCE) <table><tr><td rowspan="3" colspan="2">INSTRUCTIONSPrint or type all entries in accordance with GACAR Part 43, Appendix B</td><td>FOR GACA USE ONLY</td></tr><tr><td>Office Identification</td></tr><tr><td></td></tr><tr><td rowspan="3">1. AIRCRAFT</td><td>Make</td><td>Model</td></tr><tr><td>Serial No.</td><td>Nationality And Registration Mark</td></tr><tr><td></td><td></td></tr><tr><td rowspan="3">2. OWNER</td><td>Name (As shown on aircraft registration certificate)</td><td>Address (As shown on aircraft registration certificate)</td></tr><tr><td>Email</td><td></td></tr><tr><td></td><td></td></tr></table> 3. FOR GACA USE ONLY <table><tr><td colspan="4">4. UNIT IDENTIFICATION</td><td colspan="2">5. TYPE</td></tr><tr><td>Unit</td><td>Make</td><td>Model</td><td>Serial Number</td><td>Repair</td><td>Alteration</td></tr><tr><td>AIRFRAME</td><td>(As described in item 1 above)</td><td>(As described in item 1 above)</td><td>(As described in item 1 above)</td><td></td><td></td></tr><tr><td>POWERPLANT</td><td></td><td></td><td></td><td>□</td><td>□</td></tr><tr><td>PROPELLER</td><td></td><td></td><td></td><td>□</td><td>□</td></tr><tr><td rowspan="2">APPLIANCE</td><td>Type:</td><td></td><td></td><td>□</td><td>□</td></tr><tr><td>Manufacturer:</td><td></td><td></td><td>□</td><td>□</td></tr></table> 6. CONFORMITY STATEMENT <table><tr><td colspan="2">A. Agency's Name and Address</td><td>B. Kind of Agency</td><td>C. Certificate Number</td></tr><tr><td rowspan="3" colspan="2"></td><td>□ GACA Certificated Mechanic</td><td rowspan="3"></td></tr><tr><td>□ GACA Certificated Repair Station</td></tr><tr><td>□ Manufacturer</td></tr><tr><td colspan="4">D. I certify that the repair and/or alteration made to the unit(s) identified in Block 4 and described on the reverse or attachments hereto have been made in accordance with the requirements GACAR Part 43 and that the information furnished is correct to the best of my knowledge.</td></tr><tr><td>Date</td><td colspan="3">Name and Signature of Authorized Individual</td></tr><tr><td colspan="4"></td></tr></table> 7. APPROVAL FOR RETURN TO SERVICE <table><tr><td colspan="4">Pursuant to the authority given to persons specified below, the unit identified in Block 4 was inspected in the manner prescribed by the President of GACA and is; □ APPROVED □ REJECTED by:</td></tr><tr><td>□ GACA Inspector</td><td>□ GACA Inspection Authorization Holder</td><td colspan="2">□ Other: (Specify)</td></tr><tr><td>□ Manufacturer</td><td>□ GACA Certificated Repair Station</td><td colspan="2"></td></tr><tr><td colspan="2">Date Of Approval or Rejection</td><td>Certificate or Designation No.</td><td>Name and Signature of Authorized Individual</td></tr><tr><td colspan="2"></td><td></td><td></td></tr></table> GACA-AVSES-AIR-F049 Rev: 2, Date: 03 Sep 25 Page 1 of 2 GACA ال necesita العامه للطيران المدني General Authority of Civil Aviation [Non-Text] MAJOR REPAIR AND ALTERATION (AIRFRAME, POWERPLANT, PROPELLER OR APPLIANCE) NOTICE Mass and Balance or Operating Limitations Changes Must Be Entered In The Appropriate Aircraft Record. An Alteration Must Be Compatible With All Previous Alterations To Assure Conformity With The Applicable Airworthiness Requirement 8. DESCRIPTION OF WORK ACCOMPLISHED (Identify with aircraft registration mark, name of part repaired/altered, work accomplished, reference for approved data used and date work completed. If more space is required, attach additional sheet) Additional Sheets Attached [ ] GACA-AVSES-AIR-F049 Rev: 2, Date: 03 Sep 25 Page 2 of 2