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Block 4 The full name and address plus mailing address if different of the approved organisation releasing the items covered by this certificate. This block may be pre-printed. Logos, etc., are permitted if the logo can be contained within the block.
Block 5 Its purpose is to reference work order/contract/invoice or any other internal organisational process such that a fast traceability system can be established.
Block 6 This block is provided for the convenience of the organisation issuing the certificate to permit easy cross- reference to the 'Remarks' Block 13 by the use of item numbers. Completion is not mandatory.
Where a number of items are to be released on the certificate, it is permissible to use a separate listing cross-referring certificate and list to each other.
Block 7 The name or description of the item shall be given. Preference shall be given to use of the Illustrated Parts Catalogue (IPC) designation.
Block 8 State the Part Number. Preference shall be given to use of the IPC number designation.
Block 9 Used to indicate the Type-Approved products for which the released items are eligible for installation. Completion of block is optional but if used, the following entries are permitted:
(a)
The specific or series aircraft, engine, propeller or auxiliary power unit model, or a reference to a readily available catalogue or manual which contains such information, for example: ‘DASH8, DHC6, Do228 etc’.

(b)
‘Various’, if known to be eligible for installation on more than one model of Type-Approved product, unless the originator wishes to restrict usage to a particular model installation when it shall so state.

(c)
‘Unknown’, if eligibility is unknown, this category being primarily for use by maintenance organisations.

NOTE: Any information in Block 9 does not constitute authority to fit the item to a particular aircraft, engine, propeller or auxiliary power unit. The User/installer shall confirm via documents such as the Parts Catalogue, Service Bulletins, etc. that the item is eligible for the particular installation.
Block 10 State the number of items being released.
Block 11 State the item Serial Number and/or Batch Number if applicable, if neither is applicable, state ‘N/A’.
Block 12 The following words in quotation marks, with their definitions, indicate the status of the item being released. One or a combination of these words shall be stated in this block:
1.  
OVERHAULED

The restoration of a used item by inspection, test and replacement in conformity with an approved standard (*) to extend the operational life.

2.  
INSPECTED/TESTED The examination of an item to establish conformity with an approved standard (*).

3.  
MODIFIED The alteration of an item in conformity with an approved standard (*).

4.  
REPAIRED

The restoration of an item to a serviceable condition in conformity with an approved standard (*).

5.  
RETREADED The restoration of a used tyre in conformity with an approved standard (*).

6.  
REASSEMBLED

The reassembly of an item in conformity with an approved standard (*).
Example: A propeller after transportation.
NOTE: This provision shall only be used in respect of items which were originally fully assembled by the manufacturer in accordance with manufacturing requirements such as, but not limited to, MCAR-21.
(*) Approved Standard means a manufacturing/design/maintenance/quality standard approved by CAD.
The above statements shall be supported by reference in Block 13 to the approved data/manual/specification used during maintenance.
Block 13 It is mandatory to state any information in this block either direct or by reference to supporting documentation that identifies particular data or limitations relating to the items being released that are necessary for the User/ installer to make the final airworthiness determination of the item. Information shall be clear, complete, and provided in a form and manner which is adequate for the purpose of making such a determination.
　
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