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Each statement shall be clearly identified as to which item it relates. If there is no statement, state ‘None’.
Some examples of the information to be quoted are as follows:
Rev 0, dated 2nd March, 2010
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The identity and issue of maintenance documentation used as the approved standard.

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Airworthiness Directives carried out and/or found carried out, as appropriate.

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Repairs carried out and/or found carried out, as appropriate.

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Modifications carried out and/or found carried out, as appropriate.

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Replacement parts installed and/or parts found installed, as appropriate.

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Life limited parts history.

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Deviations from the customer work order.

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The component certificate of release to service statement referred to in point

M.A.613.
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Identity of other regulation if not CAR 145 or CAR M Subpart F.

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Release statements to satisfy a foreign maintenance requirement.

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Release statements to satisfy the conditions of an international maintenance agreement such as, but not limited to, the Canadian Technical Arrangement Maintenance and the USA Bilateral Aviation Safety Agreement 

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Maintenance Implementation Procedure.

Blocks 14, 15, 16, 17 & 18: Must not be used for maintenance tasks by M.A. Subpart F approved maintenance organisations. These blocks are specifically reserved for the release/certification of newly manufactured items in accordance with CAR 21 and national aviation regulations in force prior to CAR 21 becoming fully effective.
‘Block 19 For all maintenance carried out by maintenance organisations approved in accordance with Section A, Subpart F of CAR-M, the box “other regulation specified in block 13” shall be ticked and the certificate of release to service statement made in block
13.
The following component certificate of release to service statement referred to in point
M.A.613 shall be included in block 13:
“Certifies that, unless otherwise specified in this block, the work identified in block 12 and described in this block was accomplished in accordance with Section A, Subpart F, of CAR-M, requirements and in respect to that work the item is considered ready for release to service. THIS IS NOT A RELEASE UNDER CAR145.”
The certification statement “unless otherwise specified in this block” is intended to address the following case:
Where   the maintenance  could not be completed. 
Where   the maintenance  deviated from the standard required by this CAR-M.
Where the maintenance was carried out in accordance with a requirement other than that specified in CAR-M. In this case block 13 shall specify the particular national regulation.
Whichever  case or combination  of cases shall be specified in block 13.
Rev 0, dated 2nd March, 2010 Block 20 For the signature of the certifying staff authorised by the M.A. Subpart F approved maintenance organisation. This signature can be computer printed subject to the DGCA being satisfied that only the signatory can direct the computer and that a signature is not possible on a blank computer generated form.
Block 21 The M.A. Subpart F approved maintenance organisation reference number given by the DGCA.
Block 22 The printed name of the Block 20 signatory and personal authorisation reference.
Block 23 The date of signing the Block 19 release to service. (d/m/y). The month shall appear in letters e.g. Jan, Feb, Mar etc. The release to service shall be signed at the ‘completion of maintenance’.
Please note the User Responsibility Statements are on the reverse of this certificate. These statements may be added to the front of the certificate below the bottom line by reducing the depth of the form.
　
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