ED 2010/002/R
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Appendix III 
Airworthiness Review Certificate – EASA Form 15 
[MEMBER STATE] 
A Member of the European Union (*)
AIRWORTHINESS REVIEW CERTIFICATE 
ARC reference: ……….. 
Pursuant to Regulation (EC) No 216/2008 of the European Parliament and of the Council for the time being into force, the following continuing airworthiness management organisation, approved in accordance with Section A, Subpart G of Annex I (Part M) to Commission Regulation (EC) No 2042/2003 
[NAME OF ORGANISATION APPROVED AND ADDRESS] Approval reference: [MEMBER STATE CODE].MG[NNNN] 
has performed an airworthiness review in accordance with point M.A.710 of Annex I to Commission Regulation (EC) No 2042/2003 on the following aircraft : 
Aircraft manufacturer: .............................................................................................................. 
Manufacturer’s designation: ................................................................................................... 
Aircraft registration: ................................................................................................................. 
Aircraft serial number: .............................................................................................................
and this aircraft is considered airworthy at the time of the review.
Date of issue: .................................................... Date of expiry: ............................................ 
Signed: ............................................................... Authorisation No: ....................................... 
1st Extension: The aircraft has remained in a controlled environment in accordance with
point M.A.901 of Annex I to Commission Regulation (EC) No 2042/2003 for the last year. 
The aircraft is considered to be airworthy at the time of the issue. 
Date of issue: .................................................... Date of expiry: ............................................. 
Signed: ................................................................ Authorisation No: ....................................... 
Company Name: ................................................ Approval reference: ...................................
2nd Extension: The aircraft has remained in a controlled environment in accordance with 
point M.A.901 of Annex I to Commission Regulation (EC) No 2042/2003 for the last year. 
The aircraft is considered to be airworthy at the time of the issue.
 
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