APPLICATION FOR CASR PART 21 · PDF fileapplication form, CASA will send you ... l Birth...

Form

849

Complete this form if you are: 1) Seeking a Production Approval to manufacture aircraft, engines, propellers or aircraft parts, articles or

appliances

If at any time you would like assistance with any aspect of this form, please contact the Permission Application Centre on 136 773. Applicants are required to complete all of Parts A and D and applicable sections of Part B and C. The completion of this application form is the first step in the application process. On receipt of a completed application form, CASA will send you an estimate of the cost to process your application. You may also be asked for additional information to support the application. Should you wish to proceed, you will need to pay the estimate and provide this additional information (if requested) to the Permission Application Centre. CASA may refuse to consider an application or to consider it further while there are requirements that you have not complied with. Submit the completed application to the Permission Application Centre by email, post or fax.

ABOUT THIS APPLICATION FORM

This application is made up of six parts Part A Details of Applicant.

Part C

Accuracy of information provided

All information will be used to assess if the application meets the requirements for CASA to provide approval in accordance with CASR (1998) Part 21. An incomplete, poorly prepared or inaccurate application may:

Submitting your application Send your application, Proof of ID and supporting documentation, if required to: By post: CASA

Permission Application Centre (BNE)PO Box 2005

CANBERRA ACT 2601

By fax: 07 3144 7333

By email: [email protected]

o Result in delays.

o Add to the cost of the assessment.

o Result in refusal of the application.

Note: It is an offence to make a false declaration in this form.

o Raise doubts about the applicant(s) ability to carry out the functions of the approval.

Design Data and Quality System Information.

Part E Submitting your Application.

Details of the type of Production Approval.Part B

Applicant Declaration.Part D

APPLICATION FOR CASR PART 21

PRODUCTION APPROVAL

of 9

Submission ChecklistPart F

Privacy & Your Personal Information The information you provide in this application will be used for the purpose of an approval in accordance with CASR (1998) Part 21 application. All information received will be treated as confidential. CASA is bound by the Privacy Act to safeguard personal information within the terms of the Act.

o Result in rejection in the application

04/10 Form 849 CASR Part 21 Approval

Form

849APPLICATION FOR

CASR PART 21 PRODUCTION APPROVAL

Part A - Details of Applicant

Please note that in the guidelines and application form the 'proposed certificate holder is referred to as the 'applicant'.The name of the applicant given at A3 and A4 is the name that will appear on the certificate. In this section, you are required to provide the details of the applicant. The law requires that the permission holder must be a natural person or have legal personality (capable of enjoying and being subject to legal rights and duties) that is: • a natural person; • a group of natural persons; • an incorporated company association; . • a group of incorporated companies or association; body corporate or politic created by statute. If the applicant does not meet the above criteria, the application will not be accepted. Identification - Individuals must provide the following documentation as proof of identity, unless the documentation has previously been supplied to the Permission Application Centre, or the nominee is the holder of a valid license issued by CASA. Company's must provide the company's name as registered in the Australian Securities and Investments Commission (ASIC), the ACN or ARBN, and if you do not have a CASA ARN, provide proof of company registration with your application. For foreign applicants, please provide a copy of your nationally recognised registration record.

At least two (2) forms of Primary ID must be submitted, one to include a photograph. In the case of an applicant not having two (2) forms of Primary ID, at least one Primary and one 'Other Supporting Documentation' may be accepted at the discretion of the Permission Application Centre Officer. Acceptable forms of Identification are:

Part C - Design Data and Quality System Information

Provide information regarding the type of approval you are applying for.

Part B - Details of the type of Production Approval

Part D - Applicant Declaration

By signing the Declaration, you indicate to CASA that you have read the guidelines, completed the application in full, supplied proof of identification, accept the terms and conditions for processing your application and agree to the publication of your production approval details on the CASA website. This application must be signed by all of the applicant(s) or an agent appointed by a Power of Attorney (refer A7 - Use of an Agent). Giving false or misleading information is a serious offence.

Provide information on the desired quality system for APMA process approved and ATSO authorisation applications.

If you have any questions regarding this application or require further information on Production Approvals, please contact the Permission Application Centre on 136 773 or by email at [email protected].

Part E - Submission Checklist

The submission checklist identifies the types of documents you need to complete/send to the Permission Application Centre.

of 904/10 Form 849 CASR Part 21 Approval

Primay l Birth Certificate or birth certificate extract (to establish existence of applicant

l Australian driver's licence (with photo and signature)

l Australian or foreign passport (with photo) l Marriage certificate l Divorce decree l Foreign driver's licence (with photo) l ASIC l AUID

Other Supporting Documents l Medicare Card l Foreign aviation licence ( without photo) l Deed poll certificate l Foreign aviation licence(with photo) l Credit Card issued by an Australian Bank (with sgnature) l ID card issued to a student at an education institution with photo or signature

Form

849APPLICATION FOR


Initial Issue. Variation to existing approval.Indicate your application type:A1

Part A - Details of Applicant(s)

Are you an individual or group of individuals?

Are you an incorporated company or association?

Yes > Complete Part A3 No

Yes > Complete Part A4 No

A3 Applicant 1 Applicant 2

If there are more than 2 applicants, please attach a separate sheet containing the same details as above.

Surname

Given Names

Date of Birth

Surname

Given Names

Date of Birth

A4 Applicant 1 Applicant 2 Name of incorporated company or association or body politic:

ACN or ARBN

Name of incorporated company or association or body politic:

ACN or ARBN

A2

If you are a combination of the two please complete both A2 and A3

Do you have a CASA Aviation Reference Number (ARN?)

No

Yes ARN

Proof of ID must be with your application

Proof of ID must be with your application

No

ARNYes


Provide proof of Company registration with your application


No

Yes ARN

No

ARNYes


Provide proof of Company registration with your application


Form

849APPLICATION FOR


If you wish to authorise an agent to act on your behalf, CASA requires that the agent be appointed under a Power of Attorney. The Power of Attorney must be executed and signed by all applicants, or in the case of a company by a Director of that company.

Post Code

Registered Business Address

Business Location

A7 Are you using an agent to act on your behalf for this application?

SuburbLot / Street State Post Code

Lot / Street Suburb State Post Code

Phone Mobile Facsimile

Email

Name (in full)

Phone Mobile Facsimile

Email

Yes > enter details below. No

A6 Provide the following contact details.

Lot / Street Suburb State

(Australian Securities and Investments Commission)

(Physical address of your main base of operations)

State

Postal address

Lot / Street Suburb Post Code

Indicate the number of staff you propose to employ.A8

1-5 6-10 11-50 51-100 >100

Registration number

A5 Do you want a trading name to appear on your certificate? Yes > enter details below. No

Name (1) Registration number

Name (1)

If there are more than two names, please attach a separate sheet containing the same details as above.


Form

849APPLICATION FOR


Application for APMA. B2

Indicate the production method for which this application is made: B1

Australian Parts Manufacturer Approval (APMA) (CASR Part 21.K) >

Process Approval (CASR Part 21.K) >

Production Under a Type Certificate (CASR Part 21 Subpart F) >

Production Certificate for "One-off Parts" (CASR 21 Subpart G, Regulation 21.133 (2B)) >Production Certificate (CASR Part 21 Subpart G) >

Australian Technical Standard Order Authorisation (ATSO Authorisation) (CASR Part 21, Subpart O) and letter of ATSO Design Appproval >

Part B - Type of Production Approval

Identify the part design data and revision status:

Part Description:

Part Number of YOUR part:

OEM Part Number replaced by your part:

Is your part a "Critical Part"? (Refer to CASR Dictionary)

Yes No

If yes, describe how your part will be identified as required by CASR 21-850:

List all the products (aircraft, engine or propellers) by make, type, model and Serial Number range if applicable, on which your part will be eligible to be installed:

Note: This list will form the basis of the APMA approval when issued, therefore it must be accurate and complete.

Go to B2

Go to C1

Go to B3

Go to B4Go to B5

Go to B6Go to B7


Form

849APPLICATION FOR


Application for Process Approval. B3 Provide a description of the process including all relevant specifications:

Application for ATSO Authorisation. B4

Identify the applicable ATSO or TSO, including the revision status:

Identify the design data including revision status, which will be used to manufacture the ATSOA articles:

NoYesIs the application for Letter of ATSO Design Approval

If yes, identify the foreign country where the part, article or appliance will be manufactured:

and attach evidence of that country's NAA certification required by CASR 21.617 (1)

Production under a Type Certificate (CASR Part 21, Subpart F). B5 NoYesHas a Production Inspection System been documented and implemented?

(Refer CASR 21.123; 21.125)

If Yes, a copy must be included with this application for approval.

If No, include a copy of the Type Certificate, and provide a statement regarding development of your Production Inspection System and when this is expected to be completed.

Attached

Applications for Production Certificate for aircraft, engines or propellers. B6

Attach a copy of the Type Certificate for the product, and include a copy of the Quality System with this application. (Refer CASR 21.139, 21.143 and 21.144, 21.145).

Attached

Identify the product by make, type and model which will be manufactured under the Production Certificate.

Make Type Model

Go to C1

Go to C1

Go to C1

Go to C1


Form

849APPLICATION FOR


Applications for "one-off" Production Certificate.B7

Identify the type(s) of parts to be manufactured under the Production Certificate, e.g sheet metal parts, machined metal parts, composite material parts.

Part C - Design & Quality System Data

For APMA, Process Approval and ATSO applications include two copies of the design data with this application.

Note: Design data includes drawings, specifications, engineering reports and test reports which define the part, article or appliance for compliance with the applicable airworthiness standards of the product on which the part, article or appliance will be installed.

For APMA applications indicate whether the design data:

Is justified on the basis of similarity with the OEM part,

Is justified by Test and Computation to show compliance with the applicable airworthiness standards, or

Is attained under a licencing agreement, and attach evidence of that agreement.

Note: Design data for Production Certificates and Production under a Type Certificate is not required with this application, but must be available at the manufacturing location when the facility is assessed.

C1 Design Data.

Quality System Data.C2

Fabrication Inspection System (however described) for APMA or Process approval is attached.

Production Inspection System for products manufactured under a Type Certificate is attached, or

Indicate when this will be completed and forwarded to CASA for approval.

Quality System for a Production Certificate, "one-off" Production Certificate or ATSO is attached.

Identify the design data, including revision status, or indicate the type of design data to be used, eg "CAR (1988) 35 approved design data".


Form

849APPLICATION FOR


Part Marking.C3

Does the design and quality system data identify part marking requirements? (Refer CASR 21Q)

NoYes

If No, indicate how the parts will be identified.

D1

I am / We are signing this form as:

1. I / We declare that the information provided in this application form is true and correct.

Giving false or misleading information is an offence under the regulations.

2. I / We understand that the information provided in this application will allow CASA to calculate an estimate for service for processing this application.

3. I / We understand and agree that the cost estimate may change, and processing the application may be delayed if:

4. I / We understand and agree that for CASA to proceed with this application, I / We must:

the application does not accurately and completely identify my/our requirements; or

the details in this application are subsequently changed; or

adequately supporting documentation has not been provided.

• • •

Name Signature Date

Applicant Declaration

forward the payment; and

forward all supporting documentation to the Permission Application Centre.

• •

Individual(s) named in A3 Director(s) of the Company(s) named in A4

Part D - Applicant(s) Declaration

DateSignature Name


5. I / We give permission for CASA to send material relating to this application by email Yes NoNote: I am aware of, and accept, the risk that information sent via email may be intercepted and read during transmission, not delivered or modified. (if you do not accept, material will be sent by post)

Form

849APPLICATION FOR


Part F - Submitting Your Application

Submit the completed application to the Permission Application Centre

CASA Permission Application Centre (BNE) PO Box 2005 Canberra ACT 2601

By email: [email protected]

By fax : 07 3144 7333

By post:

This completes your application.

or

or

Part E - Submission Checklist

AttachedType Certificate for product (B6)

AttachedQuality System (B6)

AttachedFabrication Inspection System for APMA or Process approval

AttachedProduction Inspection System for products manufactured

AttachedQuality System for Production Certificate, "on-off" Production Certificate or ATSOA.

E1 Indicate what supporting documentation you have submitted in support of this applicaiton.

List any additional documentation you have provided.

If not, provide reasons / date of completionAttachedProof of ID

If not, provide reasons / date of completionAttached

Attached

NAA certification (B4)

Production Inspection System (documented & implemented) (B5)

If not, provide reasons / date of completion






After reviewing your application, CASA will advise you if any additional information is required.F1

Part F - Submitting your Application


APPLICATION FOR CASR PART 21 · PDF fileapplication form, CASA will send you ... l Birth...

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