中 国 民 用 航 空 总 局 - 中国民用航空中南地区管理局

中国民用航空总局

GENERAL ADMINISTRATION OF CIVIL AVIATION OF CHINA

改装设计批准委任单位代表申请书

APPLICATION FOR MODIFICATION DESIGN ORGANIZATION

REPRESENTITIVES

第一次申请New Application □变更Change □更新证书Renewal □

1.申请人名称Name of applicant

2.申请人地址Address of applicant

3.申请人资格类型Type of applicant Qualification

□民航总局型号合格证持有人；TC Holder of CAAC

□民航总局补充型号合格证持有人；STC Holder of CAAC

□中国境内的民航总局维修许可证的持有人；Maintenance Certificate Holder of CAAC in domestic

□民航总局运行合格证的持有人；Air Carrier Holder of CAAC

□民航总局生产许可证的持有人；PC Holder of CAAC

□其他Other ：

5．申请人持有的证书Certificate of applicant

证书类型Certificate Type

证书号Certificate Number

工作范围Work Scope

5．申请授权的项目Functi on S oug ht

( 接背面SEE REVERSE SIDE)

改装设计批准委任单位代表申请书APPLICATION FOR MDOR

6. 过去曾经做过的改装设计项目Experience Working on Modification Design Items

(如果需要可另附页Use additional sheets as necessary)

7. 联系人The point of the contact:

姓名Name

职务Title

电话Telephone

传真Fax

电子邮件E-mail

邮编ZIP

8. 我保证，本申请书所述内容准确无误I certify that the statement of this application and attachments furnished herein are correct and without error.

姓名Name

(签字signature)

职务Title

单位Organization

日期Date

(背面REVERSE SIDE)