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Begin by filling in Block 1 with your name (Last, First, Middle) and Block 2 with your Mechanic Certificate Number as shown on your FAA Mechanic’s Certificate.
In Block 3, provide your mailing address where you wish to receive Airworthiness Directives. Ensure accuracy for effective communication.
Complete Blocks 4a and 4b with your fixed base of operations and telephone number where you can be reached during normal working hours.
Answer the questions in Blocks 5 through 8 regarding your mechanic certificate history and qualifications. Be honest, as this information is crucial for processing your application.
For Block 10, indicate the number of alterations, repairs, or inspections performed during the specified renewal periods. Use the correct date format (MM/DD/YYYY).
In Block 11, list your aircraft maintenance activities over the last two years. Provide dates in descending order and describe the work performed without including job titles.
Finally, certify that all statements are true by signing and dating in Block 13 before submitting the form.
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