Advisory Circular 21 - 12

LAMPIRAN KEPUTUSAN DIREKTUR JENDERAL PERHUBUNGAN UDARA

NOMOR : SKEP/ 47 / II / 1998
TANGGAL : 28 Pebruari 1998

Advisory Circular

21 12
Application for Indonesia Airworthiness Certificates,
DAC Form 21-21

Revision : -

Date : February 1998

REPUBLIC OF INDONESIA DEPARTMENT OF TRANSPORT

DIRECTORATE GENERAL OF CIVIL AVIATION
JAKARTA - INDONESIA
 Advisory Circular 21 - 12

FOREWORD

1. Purpose : This Advisory Circular (AC) provides instructions on the preparation and
submittal of DAC Form 21-21, Application for Airworthiness Certificate.
This application shall be completed not only to obtain an airworthiness
certificate but also for any amendment or modification to a current
airworthiness certificate.

2. References : This Advisory Circular only and should be used in accordance with the
applicable regulations.

3. Revisions : Revisions of this Advisory Circular will be approved by the Director of

Airworthiness Certification, Directorate General of Air Communications.

Director General of Air Communications

ZAINUDDIN SIKADO
 Advisory Circular 21 - 12

Advisory Circular 21-12

Table of Contents

Foreword i

Table of Contents ii

1. Purpose. 1

2. Reference. 1

3. Instructions for completing DAC Form 21-21, application for 1

Airworthiness Certificates.

4. Instruction for submitting DAC Form 21-21, 7

Application for Airworthiness Certification.

5. Appendix - Sample DAC Form 21-21. 8

 Advisory Circular 21 - 12

REPUBLIC OF INDONESIA

DIRECTORATE GENERAL OF AIR COMMUNICATIONS

DIRECTORATE OF AIRWORTHINESS CERTIFICATION

ADVISORY CIRCULAR 21-12

Application for Indonesia Airworthiness Certificates, DAC Form 21-21

1. Purpose.
This advisory circular (AC) provides instructions on the preparation and submittal of DAC
Form 21-21, Application for Airworthiness Certificate. This application shall be
completed not only to obtain an airworthiness certificate but also for any amendment or
modification to a current airworthiness certificate.

2. Reference
- CASR Part 21, Certification Procedure for product and parts.
- CASR Part 45, Identification and Marking.
- SI. 21-02, Airworthiness Certification of Aircraft and Related Product.

3. Instructions for Completing DAC FORM 21-21, Application for Airworthiness

Certificates.

The applicant, or his agent, should complete Section I through IV, or II and VI, or II and
VII as applicable for the type of airworthiness certificate being requested. The following
instructions and explanations apply to the corresponding items on the form.

a) Section I. Aircraft Description.

Do not complete this section when application is being made for a Special Flight
Permit.

1) Registration Mark. Enter the Indonesian nationality designation (letter

PK-) followed by the registration marks as shown on the aircraft
registration certificate. (Reference CASR Part 45, Sub Part C).

2) Aircraft Builders Name (Make). Enter the name of the manufacturer or

builder as it appears on the aircraft identification (ID) plate. (Reference
CASR Part 45.13 (a) (1)).

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 Advisory Circular 21 - 12

a) For amateur-built aircraft, the aircraft make is the name of the

builder. When two or more persons are involved, enter only the
name of the individual that is listed first on the aircrafts ID plate.

b) For aircraft built from spare and surplus parts, the aircraft builders
name would be that of the person who assembled the aircraft and
not the name of the manufacturer who builds the same model of
aircraft under a production approval.

3) Aircraft Model Designation. Enter the model designation as shown on the

aircraft ID plate. (Trade names should not be used). (Reference CASR
Section 45.13 (a) (2)).

a) For aircraft built from spare and surplus parts, the model
designation should be that civil model which is shown on the TCDS
to which the applicant shows conformity.

b) For amateur-built aircraft, model may be any arbitrary designation

as selected by the builder. If the aircraft was purchased as a kit, the
model assigned by the kit supplier should be used.

4) Year of Manufacture. Enter the year of manufacture if shown on the

aircraft ID plate or as reflected in the aircraft logbook.

a) For aircraft eligible for standard airworthiness certificates, the year

of manufacture is the date (entered by the manufacturer) the
inspection records reflect that the aircraft is complete and meets
the DGAC - approved type design data.

b) For aircraft, other that the above, the year of manufacture is the
date of the statement in the records, entered by assembler/builder,
establishing that the aircraft is airworthy and eligible for the
certificate requested.

5) Serial Number. Enter the serial number as shown on the aircraft ID plate
per CASR Section 45.13 (a)(3).

a) For aircraft built from spare and surplus parts, enter the serial
number assigned by the builder, providing it could not be confused
with those assigned by an original manufacturer who builds the
same type of aircraft under a productions approval. It is suggested
that a letter prefix or suffix, such as the builders name or initials, be

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used with the number to provide a positive identification.

b) For amateur-built aircraft, the serial number may be any arbitrary

number assigned by the builder.

6) Engine Builders Name (Make). The engine make is the name of the
manufacturer as it appears on the engine ID plate, (Reference CASR
Section 45.13 (a) (1)). Abbreviation may be used, e.g., P&W, CMC, etc.
When no engines are installed, as in the case of a glider or balloon, enter
N/A.

7) Engine Model Designation. When engine(s) installed, enter the complete

designation as shown on the engine ID plate; e.g., R2800-99W, TVO-
435-AIA, etc. (Reference CASR section 45.13(a) (2)).

8) Number of Engines. When applicable, enter the quantity of engines

installed on the aircraft.

9) Propeller Builders Name (Make). Enter the name of the manufacturer as

shown on the propeller identification data. Enter N/A if propellers are not
installed. (Reference CASR Section 45.13 (a) (1)).

10) Propeller Model Designation. When applicable, enter the model

designation as shown on the propeller identification data (Reference
CASR Section 45.13 (a) (2)).

11) Aircraft is Import. This block should be checked only if the aircraft was
manufactured in a foreign country and is being certified under the
provisions of CASR Section 21.183 (c).

b) Section II. Certification Requested. All entries in this section are generally self-
explanatory. The following paragraphs reference applicable regulations and other
material (including examples) to assist in the completion of the application form
for each certification that may be requested.

1) Standard Airworthiness Certificate.

CASR Part 21, Section 21.183.

2) Special Airworthiness Certificate.

a) Provisional Airworthiness Certificate.

CASR Part 21, Section 21.221 for a Class I certificate and Section

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21.223 for a Class II certificate.

b) Restricted Airworthiness Certificate.

CASR Part 21, Section 21.25 and 21.185

c) Experimental Certificate
CASR Part 21, Section 21.191, 21.193 and 21.195

d) Special Flight Permit.

CASR Part 21, Section 21.197 and 21.199

3) Multiple Airworthiness Certificate, i.e., Standard / Restricted or Restricted

/ Limited.
CASR Part 21, Section 21.187.

c. Section III. Owners Certification.

Do not complete this section when application is being made for a Special Flight
Permit.

1) Registered Owner. Enter this information exactly as it is shown on the

aircraft registration certificate. CASR Part 47 prescribes the requirements
for registering aircraft.

2) Aircraft Certification Basis (Aircraft Specification or Type Certificate Data

Sheet and/or Aircraft Listing Block). This item should be completed when
application is being made for a standard, provisional, restricted, or multiple
airworthiness certificate.

a) When application is being made for multiple airworthiness

certificates, the certification basis for each certificate being
requested should be entered.

b) If the type certificate data sheet or specification for a new aircraft or

model has been approved but not yet published, the date of
approval the TC or specification number, and the word preliminary
should be entered.

c) This item is not applicable when application is being made for an

experimental certificate. N/A should be entered.

3) Airworthiness Directives. Enter ONLY the last AD NUMBER complied

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with and attached all AD Compliance List separately.

4) Supplemental Type Certificate. This block should be checked only when

one or more Supplemental Type Certificates (STC) have been
incorporated. The identification number of each STC installed is shown. If
more space is required, an attachment may be used. This block is
applicable to all certification categories. (Reference CASR Part 21, Sub
part E).

5) Aircraft Operation and Maintenance Records.

a) Records in Compliance with CASR Section 91.173. This block is

applicable to all aircraft covered by this section and should be
checked to indicate that the record keeping requirement of CASR
Section 91.173 have been met. CASR Section 91.173 requires
information which would be applicable to all aircraft; for example,
CASR Section 91.173 (a) (2) (ii) requires a record of the current
status of life-limited parts of each airframe, engine, propeller, rotor,
and appliance, while compliance with CASR Section 91.173 (a) (2)
(i ) would require that production flight test time be entered in the
aircrafts maintenance records.

b) Total Airframe Hours. This block is applicable to all aircraft covered

by this section. The total time in service of the aircraft, including
production flight test time, should be entered.

c) Experimental Only. When application is being made for the

renewal of an experimental certificate, the hours flown since the
previous experimental certificate was issued or renewed should be
entered. If the application is for an original issuance of an
experimental certificate, zero hours should be entered.

6) Certification. If signature is of the owners agent, a notarized letter from

the registered owner authorizing the agent to act on his behalf in this
matter is required.

d. Section IV. Inspection Agency Verification.

This section should be appropriately completed only if application is being made

for a standard airworthiness certificate for an aircraft being certificated under

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CASR Section 21.183 (d). This section should be left blank for all other
certification actions.

e. Section V. DGAC Representative Certification. The DGAC representative that

inspects the aircraft and issues the certificate will complete this section.

f. Section VI. Production Flight Testing. This section should be completed ONLY
BY A MANUFACTURER applying for special flight permit for the purpose of flight
testing production aircraft. (Reference CASR Section 21.197 (a) (3)).

g. Section VII. Special Flight Permit Purposes Other Than Production Flight
Test.

1) Item A. Description of Aircraft. The entries in this section should be the

same as the corresponding data recorded on the aircrafts registration
certificate and, as applicable, on the aircrafts identification plate.

2) Item B. Description of Flight. Self-explanatory except that :

a) The VIA block should contain the name of an airport or city at

some intermediate point in the flight to provide a general
description of the route flown. For example, a flight from Bandung
to Biak, may be via Ujung Pandang and Ambon. (Reference CASR
Section 21.199 (a) (2)).

b) The Duration entry should reflect the overall duration of the

special flight permit and need not be the same as the planned
duration of the actual flight. Factors such as fuelling stops, weather
conditions, overnight stops, or any other reasonable condition
should be given consideration when establishing the duration.
(Reference CASR Section 21.199 (a) (2)).

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3) Item D. The Aircraft Does Not Meet The Applicable Airworthiness

Requirements As Follows. This entry should contain in detail the ways, if
any, in which the aircraft does not comply with the applicable airworthiness
requirement. (Reference CASR Section 21.199 (a) (4).

4) Item E. The following Restrictions are Considered Necessary for Safe

Operation. This entry should contain in detail the restrictions the
applicant considers necessary for safe operation of the aircraft; for
example, reduced airspeed or weight, turbulence avoidance, crew
limitations or qualifications, and the like. (Reference CASR Section 21.199
(a) (5)).

h. Section VIII. Airworthiness Documentation. This section will be completed by

the DGAC representative who inspects the aircraft and issues the airworthiness
certificate.

4. Instruction for Submitting DAC FORM 21-21, Application for Airworthiness

Certification .
When the applicant has completed the applicable section and signed the DAC Form21-
21, it should be submitted, together with any other material that may be required by the
regulations for the airworthiness certification being requested, to the Directorate of
Airworthiness Certification.