香港特別行政區政府
民航處
Civil Aviation Department
The Government of the Hong Kong Special Administrative Region
APPLICATION FOR VALIDATION OF SUPPLEMENTAL TYPE CERTIFICATE (VSTC)
1. Applicant’s Reference
1.1 Your Reference
2. Applicant Address and Contact Data
2.1 Applicant Data
2.1.1 Name and Address
Registered Company Name
Registration Number of the
Organisation and Issuing
Authority
Registered Address
2.1.2 Contact Person
Title
Mr
Mrs
Ms
Mr
Mrs
Ms
Name
Job Title
Phone/Fax
Email
2.2 Financial Data (
2.2.1 Name and Address
Same as Field 2.1. Go to Field 3 )
Company Name
Address
2.2.2 Contact Person
Title
Name
Job Title
Phone/Fax
Email
CAD Form 33A
DCA 539 (12/2015)
Page 1 of 7
3. Identification of Activity
3.1 Change to existing Hong
Kong Supplemental Type
Certificate (HK STC)
Yes
3.2 Change to approved parts
of Flight Manual (FM)
Yes
3.3 Change to Instructions for
Continued Airworthiness
(ICA)
Yes
HK STC. No. _________________________
Revision No. ___________________________
No
Document ref. No. _____________________
No
Document ref. No. ___________________
No
4. Product Identification
4.1 Applicability
Hong Kong Type Certificate No.
Original Type Certificate No.
Type Certificate Holder
Model(s)
Eligible Aircraft Serial No.
4.2 Prototype Aircraft
Information
Registered Owner / Operator
Registration Mark
Manufacturer’s Serial No.
Intended Aircraft Input Date
Location of Aircraft Input
4.3 Certification Basis
Original HKCAD Certification
Basis for the aircraft
Proposed airworthiness code e.g.
CS-25, Amendment 10
Certification Review Items /
Issue Papers.
5. Original Approval
CAD Form 33A
DCA 539 (12/2015)
Page 2 of 7
5.1 Issuing Authority
5.2 CAA Contact Person
5.3 CAA Request Reference
5.4 STC No.
5.5 Revision/Amendment No.
5.6 Issue Date
6. Description
6.1 Title
6.2 Description
6.3 Affected Areas
(including manuals)
6.4 PSCP / CP Document
No.
6.5 Compliance Summary
Document No.
7. Demonstration of Eligibility
7.1 Design Organisation
Approval or equivalent
Issuing Authority:
Type of Approval:
Approval No.:
CAD Form 33A
DCA 539 (12/2015)
Page 3 of 7
8. Fee Information
A deposit of HK$15,000 is required for each application. Applicant for approval of STC will be
charged in accordance with Hong Kong Air Navigation (Fees) Regulations (CAP. 448 sub. leg. D),
Schedule, paragraph 9.
In the case of withdrawal of the application, or other cases of interruption, the working hours
already spent will be recovered. CAD will also recover specific costs and, if applicable, transport
costs outside Hong Kong.
CAD will return prepaid deposit to the applicant/financially responsible company after deducting
all expenditure used on the issuance of the approval. If the prepaid deposit is not sufficient to cover
the approval fee, the applicant shall pay the outstanding balance prior to issuance of a
Supplemental Type Certificate (STC).
9. Applicant’s Declaration
I confirm that all information provided in this application form is correct and complete.
I agree to pay the fees levied by the Hong Kong SAR Government in respect of the issuance of a
Supplemental Type Certificate.
I am submitting this application form, together with the following applicable documents:
a copy of the Business Registration Certificate for Field 2.1.1
the deposit of application fee, Cheque /Bank Draft No. _________________ for Field 8
financial responsibility statement by third party, letter ref. No. _______________ for Field 2.2
the owner/operator’s acknowledgement letter for Field 4.2
a copy of STC issued by other CAA referenced in Field 5
a copy of all data/documents referenced in Fields 6.4 and 6.5
a copy of all data/documents referenced on the STC
a copy of Design Organisation Approval
Name
Position in Company
Signature
Date
(DD/MM/YYYY)
This application should be sent to:
Flight Standards & Airworthiness Division
Civil Aviation Department
Civil Aviation Department Headquarters
1 Tung Fai Road, Hong Kong International Airport
Lantau, Hong Kong
Attention: Senior Airworthiness Officer (Certification)
Email:
certification@cad.gov.hk
CAD Form 33A
DCA 539 (12/2015)
Page 4 of 7
Supplemental Information and Completion Instructions for the Application
for Validation of Supplemental Type Certificate (VSTC)
The use of this form is to enable CAD to process applications without undue delay. This
section provides you with any additional instructions and requirements necessary to complete
the Application for Validation of Supplemental Type Certificate (VSTC). The individual
field of the application form may be varied in size to allow entry of all required information.
Please complete all Fields of the form clearly and legibly.
Field Name
Supplemental Information and Completion Instructions
1.1
Your Reference
Provide a unique internal reference number to this application.
This reference will be used as an identifier of your application
in all communication, e.g. demand note(s), acceptance letter,
by CAD.
Provide the name of the company and the address as they
appear on the Business Registration Certificate (or equivalent
National Companies Registration Office for organisations
located outside Hong Kong). First time applicants need to
submit a copy of the company’s Business Registration
Certificate or similar legal document stating name together
with the application. If applicable, an additional translation of
this document (done by an authorised translator, signed and
stamped) should be submitted.
2.1.1
Name and Address
In case the applicant is not a company but a natural person,
please enter the full name as it appears in the ID Card or
Passport and enter the address of registry. A copy of the
person’s ID Card or Passport needs to be provided with the first
application.
2.1.2
Contact Person
2.2.1
Financial Address
Field 2.2.2
Contact Person
Field 3
Identification of Activity
Field 4.1
Applicability
Field 4.2
Prototype Aircraft
Information
CAD Form 33A
DCA 539 (12/2015)
Self-explanatory.
Provide the (company) name and address specified in this
section which will be printed on the CAD demand note(s). A
(company) name deviating from the one entered in section
2.1.1 can only be accepted by CAD upon justified request. A
written statement, signed and stamped, from the legal entity
(third party) which is taking financial responsibility to pay the
charges is to be submitted together with the application.
Provide the name and contact details of the person that will be
contacted for all issues connected with the CAD
acknowledgement of receipt letter /demand note(s).
Self-explanatory.
Self-explanatory.
Self-explanatory.
Page 5 of 7
Field 4.3
Certification Basis
Identify the original HKCAD certification basis for the aircraft
as recorded in Type Certificate Data Sheet in field 4.1.
Identify the applicable airworthiness code proposed to be used
for CAD certification. For example: CS-25 Amendment 10.
Field 5.1
Issuing Authority
Field 5.2
CAA Contact
Field 5.3
CAA Request Reference
Field 5.4
STC No.
Field 5.5
Revision/Amendment
No.
Field 5.6
Issue Date
Field 6.1
Title
Field 6.2
Description
Field 6.3
Affected Areas
Field 6.4
PSCP / CP
Field 6.5
Compliance Summary
Document
CAD Form 33A
DCA 539 (12/2015)
Provide a list of all Certification Review Items (CRI) or Issue
Papers (IP).
Provide the name of Civil Aviation Authority (CAA) that
issues the Supplemental Type Certificate (STC).
Provide name, position, telephone no., fax no., e-mail address
and mailing address of the person from the CAA that issues the
STC.
Provide the Civil Aviation Authority (CAA) reference for
VSTC.
For example: EASA request project number 0010020011 or
FAA letter dated 2 January 2013
Self-explanatory.
Provide the STC revision /amendment number.
Provide the issue date of the STC.
Provide a title of the design change not exceeding 40
characters.
Provide a brief description of the design change.
Identify all parts of the type design and the approved manuals
affected by the design change, and the certification
specifications and environmental protection requirements with
which the change has been designed.
Self- explanatory.
Submit this application form together with a copy of Project
Specific Certification Plan (PSCP)/Certification Programme
(CP) which addresses the identification and planning of the
certification activities necessary for the grant of the STC. See
Field 9.
Self- explanatory.
Submit this application form together with a copy of
compliance summary document which lists out all compliance
summary statements or compliance reports for affected
certification basis, such as flammability report, stress analysis
etc. See Field 9.
Page 6 of 7
Field 7.1
Design Organisation
Approval or equivalent
Provide the name of the approval issuing authority.
Provide the type of Design Organisation Approval or
equivalent.
For example: EASA Design Organisation Approval (DOA) or
FAA Organisation Designation Approval
(ODA)
Submit this application form together with a copy of Approval
of Design Organisation. See Field 9.
Field 8
Fee Information
Provide the approval number of the organisation.
A deposit of HK$15,000 is required for each application.
Payment may be made by:
1.
crossed cheque in Hong Kong Dollars (HK$) payable to
“The Government of the Hong Kong Special
Administrative Region”; or
2. bank draft in Hong Kong Dollars (HK$) in favour of “The
Government of the Hong Kong Special Administrative
Region” and drawn on bank located in Hong Kong.
Field 9
Applicant’s Declaration
CAD Form 33A
DCA 539 (12/2015)
Self-explanatory.
Page 7 of 7