Free Application for Export - Certificate of Airworthiness - Federal

OMB NO. 2120-0018 12/31/2010

Form Approved

Export Certificate No.
U.S. Department of Transportation Federal Aviation Administration

Application for Export Certificate of Airworthiness

INSTRUCTIONS - This application is to be submitted to an authorized FAA representative (one copy) when the product(s) to be exported is (are) presented for inspection. Use Part I for Class I products and Part 11 for Class II. For complete aircraft execute items 1 through 11, as applicable. For engines and propellers, omit item 5A. Part III is for FAA use only Part I - Application for Export Certificate of Airworthiness (Complete items 1-11) 1. Application is made for an export certificate of airworthiness to cover the product(s) described below which is (are): USED (Aircraft) NEWLY OVERHAULED NEW 2. Name and address of exporter 3. Name and address of foreign purchaser 4. Country of destination

5. Description of product(s) Type (a) Make and Model (b) Identification No. Serial Nos. (c) FAA T.C. or Spec. No. (d) Operating time (Hours) (e)

Since Overhaul A. AIRCRAFT

Total

B. ENGINES

C. PROPELLERS

6. Does the product comply with all applicable Federal Aviation Regulations, Airworthiness Directives, and other FAA requirements? NO (Explain in ''Remarks'') YES 7. Have applicable special requirements of the importing country been complied with? NO (Explain in ''Remarks'') YES 8. Date title passed or is expected to pass to foreign purchaser: 9. For overseas shipment, preservation and packaging methods used to protect product(s) against corrosion and damage (List Spec. No. or Title): Effective duration of above methods: 10. Remarks

11. EXPORTER'S CERTIFICATION - The undersigned certifies that the above statements are true and that the product(s) described herein is (are) airworthy and in condition for safe operation except as may be noted under item 10 ''Remarks'' above. Signature of applicant or authorized representative Title Date

FAA Form 8130-1 (4-03) Supersedes Previous Edition

NSN: 0052-00-024-9005

Part II - Application for Approval of Aeronautical Parts (Complete items 12-20) 12. Name and address of exporter 13. Name and address of foreign purchaser 14. Country of destination

15. Parts are eligible for installation on 16. The parts are (Check One) 17. The parts are described (Check One) Below by name, part number and quantity Name (a)

Make and model Class I product

FAA Spec. No. or T.C

NEW

NEWLY OVERHAULED Invoice/packing sheet No.

On the attached invoice or packing sheet, by name, part number and quantity Part number (b) Quantity (c)

18. Have applicable special requirements of the importing country been complies with?

YES

NO (Explain in item 10 ''Remarks')

19. Preservation and packaging methods used to protect parts against corrosion and damage (List Spec. No. or Title): Effective duration of above methods: 20. Exporter's Certification - I certify that the foregoing statements are true and that the parts described herein are airworthy, conform to FAA approved design data, are in condition for safe operation except as may be noted in item 1 0 ''Remarks'' Signature of applicant or authorized representative Title Date

Part III - Approval (FOR FAA USE ONLY) 21. It is considered that the product(s) described in Part I or Part II is (are) airworthy and conform(s) to pertinent requirements except as noted in Item 10. (Check One) Signature Number

Part I Date

Part II

(Check one)

DMIR

DAR

DOA

ODAR Quantity

FAA Inspector

22. Give quantity of approval tags, FAA Form 8130-3, issued for the parts described in Part II. 23. EXPORT FILE SPOT-CHECKED BY: FAA Supervising Inspector D.O. No.

Date

FAA Form 8130-1 (4-03) Supersedes Previous Edition

· U.S. Government Printing Office: 1996 - 405-552/45303

NSN: 0052-00-024-9005

U.S. Department of Transportation Federal Aviation Administration

APPLICATION FOR EXPORT CERTIFICATE OF AIRWORTHINESS
Supplemental Information and Instruction

Privacy Act Statement
Information on FAA Form 8130-1, Application for Export Certificate of Airworthiness is solicited under the authority of 49 U.S.C. 44103 as implemented by 14 CFR Part 21. The purpose of this information is to evaluate an applicant's application for an export airworthiness approval for a Class I or Class 11 product. Submission of this data is mandatory and will become part of the Privacy Act system of records DOT/FAA 801, Aircraft Registration System. Incomplete submission may result in delay or denial of your request. Information maintained in the Privacy Act system of records is routinely used to (1) provide aircraft owners and operators information about potential mechanical defects or unsafe conditions of their aircraft in the form of airworthiness directives, (2) locate specific individuals or aircraft for accident investigation, violation, or safety related requirements, (3) prepare an Aircraft Registry in magnetic tape and microfiche form as required by ICAO agreement, containing information on aircraft owners by name, address, United States Registration Number, and type of aircraft, and (4) DOT Prefatory Statement of General Routine Uses.

Paperwork Reduction Act Statement:
This information is collected for the purpose of issuing an Export Airworthiness Approval to any applicant meeting the criteria established in FAA Order 8130.2, Airworthiness Certification of Aircraft and Related Products. The FAA uses the information to maintain and update the current database database or aircraft having obtained approved airworthiness certificates. The burden associated with completing FAA Form 8130-2 is 12 minutes. Providing this information is mandatory if an applicant wishes to obtain an export airworthiness approval. The information is protected under the provisions of the Privacy Act and the Privacy Act system of records DOT/FAA-801, Aircraft Registration System. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number associated with this collection of information is 2120-0018. Comments concnerning the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ABA-20.

Tear off this cover sheet before submitting this form.

FAA Form 8130-1 (4-03) Supersedes Previous Edition

NSN: 0052-00-024-9005