052-lsa-application-for-certification-of-airworthiness

gaca_gov_sa · form · processed · 1 chunks

document_type=form entity=format:application/pdf entity=language:ar language=en taxonomy_l1=transport taxonomy_l2=aviation taxonomy_l3=aircraft_certification validity=valid validity_confidence=0.6

GACA
ال necesita للطيران المدني
General Authority of Civil Aviation
[Non-Text]
LSA - APPLICATION FOR CERTIFICATION OF AIRWORTHINESS
<table><tr><td colspan="4">I. AIRCRAFT DESCRIPTION (Refer to aircraft manufacturer&#x27;s Data Plate)</td></tr><tr><td>Registration Mark</td><td>Aircraft Builder&#x27;s Name (Make)</td><td>Aircraft Model Designation</td><td>Year of Mfg.</td></tr><tr><td></td><td></td><td></td><td></td></tr><tr><td>Aircraft Serial No.</td><td>Engine Builder&#x27;s Name (Make)</td><td>Engine Model Designation</td><td>Aircraft Is</td></tr><tr><td></td><td></td><td></td><td>□ New □ Used</td></tr></table>
II. LIGHT SPORT AIRCRAFT SPECIAL CERTIFICATE CATEGORY
<table><tr><td>Light Sport</td><td>□ Airplane</td><td>□ Power Parachute</td><td>□ Weight shift control</td><td>□ Glider</td><td>□ Other</td></tr><tr><td>Reason</td><td>□ Initial Issue</td><td>□ Renewal</td><td>Request Period</td><td colspan="2">Yrs.</td></tr></table>
III. OWNER'S CERTIFICATION
<table><tr><td colspan="4">A. Registered Owner (As shown on Certificate of Aircraft Registration)</td></tr><tr><td>Name</td><td></td><td>Email</td><td></td></tr><tr><td colspan="4">Address</td></tr><tr><td colspan="4">B. Aircraft Operation and Maintenance Records</td></tr><tr><td>☐</td><td>Check If Records Are in Compliance with GACAR § 91.457</td><td colspan="2">Total Airframe Hours (Enter for Used Aircraft Only)</td></tr><tr><td></td><td></td><td colspan="2"></td></tr><tr><td colspan="4">Certification: “I hereby certify that I am the owner (or his agent) of the aircraft described above: that the aircraft is registered in the Kingdom of Saudi Arabia in accordance with GACAR Part 47 and that the aircraft has been inspected and is airworthy and eligible for the airworthiness certificate requested”</td></tr><tr><td>Date of Application</td><td>Title</td><td>Name: (Print or Type)</td><td>Signature</td></tr><tr><td></td><td></td><td></td><td></td></tr></table>
IV. INSPECTION AGENCY VERIFICATION
<table><tr><td colspan="4">The aircraft described above have been inspected and found airworthy by</td></tr><tr><td>□</td><td>Certificated Repairman(Give Certificate No.)</td><td>□</td><td>Certificated Mechanic(Give Certificate No.) □</td></tr><tr><td></td><td></td><td></td><td></td></tr><tr><td colspan="2">Date</td><td colspan="2">Name</td></tr><tr><td colspan="2"></td><td colspan="2"></td></tr></table>
V. GACA REPRESENTATIVE CERTIFICATION
I find that the aircraft described in the Section above meets the requirements for the certification requests or the amendment of the Airworthiness Certificate
<table><tr><td>Date</td><td>Title</td><td>Name</td><td>Signature</td></tr><tr><td></td><td></td><td></td><td></td></tr></table>
<table><tr><td>INSTRUCTIONS</td><td>Print or type. Submit/upload it in GACA Portal with all required forms and documents.Make sure all uploaded documents and forms are updated.Unless all required documents and all the entries on this form are completed accurately and fully, the issue of an Airworthiness certificate may be delayed.</td></tr></table>
GACA-AVSES-AIR-F052
Rev: 2, Date: 07 Sep 25
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