Faa Form 8130-1 - Application For Export Certificate Of Airworthiness Page 2
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2Part II – Application for Approval of Articles (Complete items 12-20)
14. Country of destination
12. Name and address of exporter
13. Name and address of foreign purchaser
Make and model of product
FAA Spec. No. or T.C.
15. Articles are eligible for installation on
_______________
16. The articles are (Check One)
NEW
USED
17. The articles are described (Check One)
Invoicing/packing sheet No.
Below by name, part number and quantity
On the attached invoice or packing
sheet by name, part number and quantity
Name
Part number
Quantity
(a)
(b)
(c)
18. Have applicable special requirements of the importing country been complied with?
YES
NO (Explain in item 10 “Remarks”)
19. Preservation and packaging methods used to protect articles against corrosion and damage (List Spec. No. or Title):
Effective duration of above methods:
20. Exporters Certification – I certify that the foregoing statements are true and that the articles described herein are airworthy, conform to
FAA approved design data, are in a condition for safe operation except as may be noted in item 10 “Remarks”.
Signature of applicant or authorized representative
Title
Date
Part III – Approval (FOR FAA USE ONLY)
21. It is considered that the product(s) and articles described in Part I or Part II is (are) airworthy
and conform(s) to pertinent requirements except as noted in Item 10. (Check One)
Part I
Part II
Signature
Number
Date
(Check one)
ODA
DMIR
DAR
FAA Inspector
22. Give quantity of approval tags, FAA Form 8130-3, issued for the articles described in Part
Quantity
II.
23. EXPORT FILE SPOT-CHECKED BY:
D.O. No.
Date
FAA Supervising Inspector
FAA Form 8130-1 (04/2011) Supersedes Previous Edition
Electronic Format - PDF
NSN: 0052-00-024-9005
Page 2 of 2
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