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Rev 0, dated 2nd March, 2010
1. DGCA INDIA  2. AUTHORISED RELEASE CERTIFICATE CA FORM 1  3. FORM TRACKING NUMBER 
4. Approved Organisation Name and Address  5. Work Order/Contract/Invoice 
6. Item  7. Description  8. Part No  9.Eligibility*  10.Qty  11. Serial/Batch No  12.Status/Work 
13. Remarks 
14. Certifies that the items identified above were manufactured in conformity to: . approved design data and are in condition for safe operation . non-approved design data specified in block 13  19. CAR 145.A.50 Release to service  Other regulation specified in block 13 
Certifies that unless otherwise specified in block 13,the work identified in block 12 and described in block 13, was accomplish in accordance with CAR-145 and in respect to that work the items are considered ready to release to service 
15. Authorised Signature  16. Approval/Authorisation Number  20.Authorised Signature  21. Certificate/Approval Ref No. 
17. Name  18. Date(d/m/y)  22. Name  23. Date(d/m/y) 

CA Form 1     *Installer must cross-check eligibility with applicable technical data
Rev 0, dated 2nd March, 2010
                                           Authorised release certificate
CA Form I
USER/INSTALLER RESPONSIBILITIES
NOTE:
1.  
It is Important to understand that the existence of the document alone does not automatically constitute authority to install the part/component/assembly.

2.  
Where the user/installer works in accordance with the national regulations of an airworthiness authority different from the airworthiness authority specified in block I it is essential that the user/installer ensures that his/her airworthiness authority accepts parts/components/assemblies from the airworthiness authority specified in block I.

3.  
Statements 14 and 19 do not constitute installation certification.  In all cases the aircraft maintenance record shall contain an installation certification issued in accordance with the national regulations by the user/installer before the aircraft may be flown.

Rev 0, dated 2nd March, 2010
 Section 2 CAR M Appendix III    Airworthiness Review certificate
DGCA INDIA
AIRWORTHINESS REVIEW CERTIFICATE
ARC reference: ……………………………………….
Pursuant to DGCA Regulations for the time being into force, the DGCA hereby certifies that the following aircraft 
Aircraft Manufacturer:………………………………………………..
Manufacturer’s designation: …………………………………………
Aircraft registration: ………………………………………………….
Aircraft Serial number : ……………………………………………….

Is considered airworthy at the time of this review.

Date of issue: …………………………………………………… Date of Expiry ……………………………………….
　
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