Appendix I F1

United Kingdom

If there is not enough space to list the information in the space of the declaration, the information shall be listed in a separate annex. The annex shall be dated and signed.
If the aircraft is also registered with an AOC holder, specify the AOC number of the AOC holder.
‘ Type(s) of operation ’ refers to the type of operations conducted with this aircraft, e.g. non-commercial operations or specialised operations such as aerial photography flights, aerial advertising flights, news media flights, television and movie flights, parachute operations, skydiving, maintenance check flights.
Information about the organisation responsible for the continuing airworthiness management includes the name of the organisation, the address and the approval reference.
DECLARATION in accordance with Commission Regulation (EU) No 965/2012 on air operations
Operator Name: Place in which the operator has its principal place of business or, if the operator has no principal place of business, place in which the operator is established or residing and place from which the operations are directed: Name and contact details of the accountable manager:
Aircraft operation
Starting date of operation or applicability date of the change:
Information on aircraft, operation and continuing airworthiness management organisation ^f1 :
Aircraft MSN	Aircraft type	Aircraft registration ^f2	Main base	Type(s) of operation ^f3	Organisation responsible for the continuing airworthiness management ^f4




Where applicable, details of approvals held (attach list of specific approvals, including specific approvals granted by a third-country, to the declaration, if applicable).
Where applicable, details of specialised operations authorisation held (attach authorisations, if applicable).
Where applicable, list of alternative means of compliance with references to the associated AMCs they replace (attach AltMoC).
Statements
□The operator complies, and will continue to comply, with the essential requirements set out in Annex V to Regulation (EU) 2018/1139 of the European Parliament and of the Council and with the requirements of Regulation (EU) No 965/2012. □The management system documentation, including the operations manual, comply with the requirements of Annex III (Part-ORO), Annex V (Part-SPA), Annex VI (Part-NCC), or Annex VIII (Part-SPO) to Regulation (EU) No 965/2012 and all flights will be carried out in accordance with the provisions of the operations manual as required by point ORO.GEN.110(b) of Annex III to that Regulation.
□All aircraft operated hold a valid certificate of airworthiness in accordance with Commission Regulation (EU) No 748/2012 or meet the specific airworthiness requirements applicable to aircraft registered in a third country and subject to a lease agreement.
□All flight crew members hold a licence in accordance with Annex I to Commission Regulation (EU) No 1178/2011 as required by point ORO.FC.100(c) of Annex III to Regulation (EU) No 965/2012 and cabin crew members, where applicable, are trained in accordance with Subpart CC of Annex III to Regulation (EU) No 965/2012.
□(If applicable) The operator has implemented and demonstrated conformity to a recognised industry standard. Reference of the standard: Certification body: Date of the last conformity audit:
□The operator will notify to the F2CAA any changes in circumstances affecting its compliance with the essential requirements set out in Annex V to Regulation (EU) 2018/1139 and with the requirements of Regulation (EU) No 965/2012 as declared to the CAA through this declaration and any changes to the information and lists of AltMoC included in and annexed to this declaration, as required by point ORO.GEN.120(a) of Annex III to Regulation (EU) No 965/2012.
□The operator confirms that the information disclosed in this declaration is correct.
Date, name and signature of the accountable manager

Annotations

Textual amendments

F1: Substituted by Commission Implementing Regulation (EU) 2019/1384 of 24 July 2019 amending Regulations (EU) No 965/2012 and (EU) No 1321/2014 as regards the use of aircraft listed on an air operator certificate for non-commercial operations and specialised operations, the establishment of operational requirements for the conduct of maintenance check flights, the establishment of rules on non-commercial operations with reduced cabin crew on board and introducing editorial updates concerning air operations requirements (Text with EEA relevance).
F2: Word in Annex 3 Appendix 1 substituted (31.12.2020) by The Aviation Safety (Amendment etc.) (EU Exit) Regulations 2019 (S.I. 2019/645), regs. 1, 365(b) (with Sch. 3) (as amended by S.I. 2019/1098, regs. 1(3), 12 and S.I. 2020/1116, regs. 1(3), 45(b)); 2020 c. 1, Sch. 5 para. 1(1)

Footnotes

f1: If there is not enough space to list the information in the space of the declaration, the information shall be listed in a separate annex. The annex shall be dated and signed.
f2: If the aircraft is also registered with an AOC holder, specify the AOC number of the AOC holder.
f3: ‘ Type(s) of operation ’ refers to the type of operations conducted with this aircraft, e.g. non-commercial operations or specialised operations such as aerial photography flights, aerial advertising flights, news media flights, television and movie flights, parachute operations, skydiving, maintenance check flights.
f4: Information about the organisation responsible for the continuing airworthiness management includes the name of the organisation, the address and the approval reference.