AC 21–12D CHAPTER 9. SECTION IV, INSPECTION AGENCY VERIFICATION Complete this section only for standard airworthiness applications of used aircraft or surplus U.S. military aircraft (except an experimental aircraft that previously had been issued a different airworthiness certificate under this section). To qualify for a standard airworthiness certificate, show the aircraft conforms to a type design approved under a TC or an STC. The aircraft must also be in compliance with all applicable FAA issued ADs. The aircraft must be inspected and found airworthy by one of four methods (refer to paragraphs 9.1 through 9.4 of this section). The aircraft has been inspected in accordance with the performance rules for 100-hour inspections, refer to 14 CFR 43.15, or an equivalent performance standard acceptable to the FAA (refer to 14 CFR 21.183(d)(2)).
Note: Do not complete this section when applying for an amended certificate, § 21.177.
9.1 Title 14 CFR Part 121 Certificate Holder.
Mark this box and enter the certificate number when the aircraft has been inspected and found airworthy by a Part 121 certificate holder.
9.2 Certificated Mechanic.
Mark this box and enter the certificate number when the aircraft has been inspected and found airworthy by a certificated mechanic.
9.3 Certificated Repair Station.
Mark this box and enter the certificate number when the aircraft has been inspected and found airworthy by a mechanic at a certificated repair station.
9.3.1 Certificated Foreign Repair Station.
Mark this box and enter the name (and number if applicable) of the foreign maintenance organization that inspected and found the aircraft airworthy if all of the following are met:
• The U.S. has a bilateral agreement with implementation procedures with the exporting country that includes acceptance of this aircraft category by the U.S. for import,
• The inspection was performed by a maintenance organization appropriately certificated by the exporting CAA, and
• The inspection was completed while the aircraft was operated on the registry of the exporting CAA and within 60 days of submitting the application for a U.S.
airworthiness certificate.
9.3.2 Reserved.
9-1
AC 21–12D
9.4 Aircraft Manufacturer.
Mark this box and enter the manufacturer name when the aircraft has been inspected and found airworthy by the manufacturer who holds the TC.
9.5 Date.
Enter the date the inspection agency attests to the verification statement. Enter the date in month/day/year format (for example, “02/09/2025”).
9.6 Name and Title.
Print the name and title of the authorized person at the inspecting agency who completed the inspection as entered in the aircraft logbook. A full name may include first middle initial as appropriate, and last name. Titles may include mechanic, technician, inspector, manager, or director. “John E. Doe, Avionics Technician” and “John Doe, Director of Quality Assurance” are some examples of a full name and title.
9-2
AC 21–12D CHAPTER 10. SECTION VI, PRODUCTION FLIGHT TESTING Note 1: Manufacturers applying for a special flight permit with the purpose of flighttesting production aircraft, complete this section. Refer to 14 CFR 21.197(a)(3).
Note 2: Manufacturers producing fully assembled aircraft in the light sport category, in AWC, select Light Sport Aircraft, on Form 8130-6, complete only items A and C. Item B should be left blank. Refer to 14 CFR 21.197(a)(3).
10.1 Item A, Manufacturer.
10.1.1 Name.
Enter the name of the manufacturer or legal name of the company.
10.1.2 Address.
Enter the company’s full physical address, which includes street address, city, state, and zip code.
10.2 Item B, Production Basis.
10.2.1 Production Certificate.
Mark this box if the manufacturer holds a PC and has produced the aircraft under this certificate. If the box is marked, a PC number should be entered in the data field space.
10.2.2 Type Certificate.
Mark this box if this aircraft was produced under a TC and not a PC.
10.2.3 Aircraft That May Not Currently Meet Applicable Airworthiness Requirements But Is Capable of Safe Flight.
Mark this box for an aircraft that may not currently meet applicable airworthiness requirements but is capable of safe flight.
10.3 Item C.
10.3.1 Give Quantity of Certificates Required for Operating Needs.
Manufacturers in serial production can request more than one certificate per application submitted. Enter the quantity (in digits) of certificates needed for the operation. For example, entering “4” requests four certificates for use during production flight tests that can be transferred from one aircraft to another.
10-1
AC 21–12D
10.3.2 Date of Application.
Enter the current date as the special flight permit application date in the month/day/year format (for example, “02/09/2025”).
10.3.3 Name and Title.
Enter (print or type) the full name and title. A full name usually includes first name, a middle initial, and last name. Titles may include owner, president, director, or authorized agent. “John E. Doe, Owner” and “John Doe, Director of Quality Assurance” are some examples of a full name and title. If application is completed by the owner’s agent, a notarized letter from the aircraft’s registered owner authorizing the agent to act on the owner’s behalf should be included (upload to AWC if necessary).
10.3.4 Signature.
The person whose name appears in the “Name and Title” data field should sign this data field. Paper Form 8130-6 user should ink sign. For AWC users, AWC provides for electronic signatures.
10.3.5 AWC Review and FAA Office Information.
When using AWC, prior to submitting your application to the FAA, review the application for completeness and accuracy. Once review of the application is complete, select the applicable FAA office. Refer to the FAA website to determine the applicable FAA office, Locate an Office.
10-2
AC 21–12D CHAPTER 11. SECTION VII, SPECIAL FLIGHT PERMIT PURPOSES OTHER THAN
PRODUCTION FLIGHT TEST
11.1 Item A, Description of Aircraft.
Entries in this section should match the data recorded on the aircraft’s registration certificate and the aircraft’s ID plate as applicable.
11.1.1 Registered Owner.
Enter the name on the aircraft’s registration certificate.
11.1.2 Address.
Enter the owner’s address listed on the aircraft’s registration certificate.
11.1.3 Builder.
Enter the name of the manufacturer or builder as it appears on the aircraft’s ID plate.
11.1.4 Model.
Enter the model designation as shown on the aircraft’s ID plate.
11.1.5 Serial Number.
Enter the serial number as shown on the aircraft ID plate.
11.1.6 Registration Mark.
Enter the U.S. nationality designator letter “N” followed by the registration marks as shown on the aircraft registration certificate.
11.2 Item B, Description of Flight.
11.2.1 Customer Demonstration Flights.
Mark this data field if the special flight permit is for a customer demonstration flight.
11.2.2 From.
Enter the aircraft’s current location (for example, “Kansas City, Missouri”, or the airport identifier “MCI”).
11.2.3 To.
Enter the aircraft’s intended destination (for example, “Dallas, Texas”, or the airport identifier “DFW”).
11-1
AC 21–12D
11.2.4 Via.
This data field should contain the name(s) of an airport or city at some intermediate point(s) in the flight. Entering “via” points provides a general direction of the flight route (refer to 14 CFR 21.199(a)(2)). For example, a flight from “Kansas City, Missouri” (or “MCI”), to “Dallas, Texas” (or “DFW”), may be flown via “Wichita, Kansas” (or “ICT”), and “Oklahoma City, Oklahoma” (or “OKC”). Leave this data field blank if there are no planned intermediate points.
11.2.5 Departure Date.
Enter the date the flight is planned using month/day/year format (for example, “02/09/2025”).
11.2.6 Duration.
The duration is the length of time needed for the special flight permit. The duration is not the same as the planned duration of the actual flight. Factors such as fueling stops, weather conditions, overnight stops, or any other reasonable condition should be given consideration when establishing the duration. The length of time needed for the aircraft to reach its intended destination should be given in whole number days or weeks (for example, “7 days” or “2 weeks”) (refer to 14 CFR 21.199, Issue of special flight permits).
11.3 Item C, Crew Required to Operate the Aircraft and Its Equipment.
In this section, mark the boxes of the crew required to operate the aircraft and its equipment. If additional crew members other than the ones listed in boxes are necessary, mark the “Other” box. Enter the additional required crew member’s function (for example, test engineer, avionics technician) in the space provided to the right of the “Other” box.
11.4 Item D, The Aircraft Does Not Meet the Applicable Airworthiness Requirements as Follows.
In the space provided, detail the conditions where the aircraft does not comply with the applicable airworthiness requirements. Keep in mind this is the basis for requesting a special flight permit and will need to be specific (refer to 14 CFR 21.199(a)(4)).
11.5 Item E, The Following Restrictions Are Considered Necessary for Safe Operation.
In the space provided, enter any restrictions considered necessary for safe operation of the aircraft (for example, reduced airspeed, operating weight, turbulence avoidance, crew limitations, or qualifications). The application will be reviewed, and additional conditions and/or limitations may be prescribed for safe operation (refer to 14 CFR 21.199(a)(5) and (6)).
11-2
AC 21–12D
11.6 Item F, Certification.
If this section applies to the application, read the certification statement and verify that requirements have been met before completing this item. There are three blocks to complete:
11.6.1 Date of Application.
In this data field, enter the current date using month/day/year format (for example, “02/09/2025”).
11.6.2 Name and Title.
Enter (print or type) the full name and title. A full name usually includes first name, a middle initial, and last name. Following the full name, the data field requests the title of that person. Titles may include owner, president, director, or authorized agent. “John E.
Doe, Owner” or “John E. Doe, Director of Quality Assurance” are some examples of a full name and title. If application is completed by the owner’s agent, a notarized letter from the aircraft’s registered owner authorizing the agent to act on the owner’s behalf should be included (upload to AWC if necessary)
11.6.3 Signature.
The person whose name appears in the “Name and Title” data field should sign the data field. When using the paper version of FAA Form 8130-6 the user should ink sign. For AWC users, AWC provides for electronic signatures.
11-3
AC 21–12D CHAPTER 12. AWC PROJECT DOCUMENTATION Note 1: This section of AWC is used to upload documents related to the AWC application that are requested.
Note 2: Do not include or upload any information that is proprietary, confidential, company-sensitive, subject to International Traffic in Arms Regulations (ITAR) (22 CFR, subchapter M), subject to Export Administration Regulations (EAR) (15 CFR part
734), otherwise restricted from public or foreign disclosure, or documents that are not applicable to applying for an airworthiness certificate.
12.1 AWC Project Documents.
This section of AWC is used to upload documents related to the AWC application that are requested. Documents may include, but are not limited to:
• Program letter. Refer to § 21.193 Experimental certificates: general, for information on program letters.
• Drawings or photographs.
• Notarized letter of authorization.
• Amateur-built eligibility statement.
12.2 AWC Designee Tab.
AWC allows applicants to request a desired designee to be considered for assignment to this application. Please note that this is only a request and will be taken into consideration by the FAA. Circumstances may require the FAA to reject the requested designee, requiring the applicant to seek and request another designee, or it may be assigned to an FAA ASI. The FAA recommends that the applicant communicate with the requested designee, if known, prior to requesting in AWC.
12.3 AWC Review and FAA Office Information.
When using AWC, prior to submitting the application to the FAA, review the application for completeness and accuracy. Once review of the application has been completed, select the applicable FAA office. Refer to the FAA website to determine the applicable FAA office, at Locate an Office. Select the review box then the Submit Application button. In AWC, a prompt appears to accept the consent of signing the application digitally (Figure 1). Once accepted, the name of the person submitting the application will appear in the signature box preceded by “signed by” and followed by a digital time/date stamp.
12-1
AC 21–12D Figure 1. Application Consent Statement
12.4 Submitting the Completed Paper FAA Form 8130-6.
Once completed and signed, the Form 8130-6 is submitted to the selected FAA office.
Be prepared to provide additional documentation required by the regulations for final airworthiness certification. For an authorized agent to act on someone’s behalf, a notarized letter of authority should be included with the application form. For manufacturers holding an FAA production approval, an application may be submitted to an authorized Designated Airworthiness Representative, Designated Manufacturing Inspection Representative, or Organization Designation Authorization unit member, as appropriate.
Note: For questions or concerns regarding your submitted application, contact the FAA office to which it was submitted.
12-2
AC 21–12D Appendix A APPENDIX A. RELATED MATERIAL A.1 Title 14, Code of Federal Regulations (14 CFR).
The following 14 CFR parts are related to this AC. You can download the full text of these regulations from the Federal Register website at eCFR and on DRS.
• Part 1, Definitions and Abbreviations, provides definitions for terms used in the application.
• Part 21, Certification Procedures for Products and Articles, sets forth rules for the issuance of and change to type certificates, and issuance of production certificates, airworthiness certificates, and export airworthiness approvals. It also sets forth the rules governing the holders of these certificates and the approval of certain articles.
• Part 39, Airworthiness Directives, provides a legal framework for the FAA’s system of Airworthiness Directives.
• Part 43, Maintenance, Preventive Maintenance, Rebuilding, and Alteration, sets forth rules governing the maintenance, preventive maintenance, rebuilding, and alteration of aircraft having a U.S. Airworthiness Certificate, certain foreign-registered aircraft, and related products and articles.
• Part 45, Identification and Registration Marking, sets forth rules for display of nationality and registration marks, display of special airworthiness classification marks, identification plates for products, and identification of certain replacement and critical aircraft articles.
• Part 47, Aircraft Registration, sets forth rules for registering an aircraft.
• Part 91, General Operating and Flight Rules, sets forth rules governing the operation of most aircraft within the United States.
• Part 121, Operating Requirements: Domestic, Flag, and Supplemental Operations, sets forth rules for air carriers conducting domestic, flag, and supplemental operations, including safety and operational standards, including airman and crewmember qualifications, training programs, flight time limitations, aircraft maintenance, and equipment requirements for scheduled airlines and large cargo carriers.
A.2 FAA Advisory Circulars.
The following ACs are related to the guidance in this AC. The latest version of each AC referenced in this document is available on the FAA website at FAA Advisory Circulars and on DRS.
• AC 20-27, Certification and Operation of Amateur-Built Aircraft.
• AC 21-4, Special Flight Permits for Operation of Overweight Aircraft.
• AC 21-37, Primary Category Aircraft.
A-1
AC 21–12D Appendix A
• AC 2 1 -54, Experimental Airworthiness Certification of Certain Former Military Aircraft.
• AC 39-7, Airworthiness Directives.
• AC 45-2, Identification and Registration Marking.
A.3 FAA Orders.
The following orders are related to the guidance in this AC. The latest version of each order referenced in this document is available on the FAA website at FAA Orders & Notices and on DRS.
• FAA Order 8130.2, Airworthiness Certification of Aircraft.
• FAA Order 8130.34, Airworthiness Certification of Unmanned Aircraft Systems and Optionally Piloted Aircraft.
• FAA Order 8110.56, Restricted Category Type Certification.
A.4 FAA Forms and Other Related Material.
The following forms are related to the guidance in this AC. They are available on the FAA website at Forms, DRS, or Airworthiness Certification of Aircraft.
• FAA Form 8130-6, Application for U.S. Airworthiness Certificate, see Figure A-1.
• FAA Form 8130-15, Manufacturer’s Statement of Compliance for a Light-Sport Category Aircraft/Kit.
• Airworthiness Certification (AWC) tool.
• AWC Applicant Registration Guide and Application Process Overview.
A-2
AC 21-12D Appendix A Figure A-1. Sample FAA Form 8130-6 (Front) FAA FORM 8130-6, APPLICATION FOR U.S. AIRWORTHINESS CERTIFICATE For Approved OMB No. 2120-0018 Expires: October 31, 2026 U.8. Department U.S. AIRWORTHINESS APPLICATION FOR FAA use only. Bubmit original only to an authorized FAA Representative. If INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for of Transportation additional space is required, use attachment. For special flight perits Federal Aviation CERTIFICATE complete Sections II, VI, and VII as applicable Administration
1. REGISTRATION MARK 2. AIRCRAFT MANUFACTURE'S oF BUILDER'S NAME 3. AIRCRAFT MODEL DESIGNATION LAIRCRAFT DESCRIPTION 5. AIRCRAFT SERIAL NO. 6. ENGINE MAI FACTURE'S oF BUILDER'S NAME 7. ENGINE MODEL DESIGNATION
8. NUMBER OF ENGINES 9. PROPELLER MANUFACT URE'S or BUILDER'S NAME 10. PROPELLER MODEL DEBIONATION 11. AIRCRAFT 13 /Cheak if applebie IMPORT
APPUCATION IS HEREBY MADE FOFE STANDARD AIRWORTH CATE (indicate calepory) NORMAL UTILITY ACROBATIC TRANSPORT POMMUTER ALLOON OTHER PECIAL AIRWORTHINEBS CERTIFICATE (Check appropriale /ema)
PRIMARY Powered-Parachute Weight-Bhift-Control 4 alder LIGHT-SPORT (Indiate Cal Fiotorcraft: Powered-Lit Ughter-than Ar Other (Spesty) 2 LIMITED PROVISIONAL (Indiate dies) CLABBI CLASS II
AGRICULTURE AERIAL SURVEY WEATHER CONTROL RESTRICTED FOREST and WILDLIFE CONBERVATION PATROLLING AERIAL ADVERTIBING OTHER (SpearM) Special Purpose Operation(a) (Spear)
RESEARCH AND DEVELOPMENT AMATEUR-BUILT TEXHIBITION
AIR RACING CREW TRAINING MARKET SURVEY
SHOW COMPLIANCE WITH THE OFR OPERATING PRIMARY CATEGORY KIT-BULT ARORAFT
OPERATING FORMER MILITARY AIRORAFT EXPERIVENTAL PURPOSE Operating Light-Sport Category Kit-Bult Aircraft Operating Former Light-Sport Catepory Aircraft (prevlousty Issued §21.190 alwo less certificate) 12A RESEARCH AND DEVELOPMENT 12 UNMANNED AIRCRAFT 12 B MARKET SURVEY 12 D EXHIBITION 12 C CREW TRAINING 12 E BHOW COMPLIANCE WITH THE OFF.
FERRY FLIGHT FOR REPAIRS, ALTERATIONS, MAINTENANCE, OR STORAGE
SPECIAL FLIGHT EVACUATE FROM AREA OF IMPENDING DANGER
OPERATION IN EXCESS OF MAXIMUM CERTIFICATED TAKE-OFF WEIGHT
DELIVERINO OR EXPORTINO PRODUCTION FLIGHT TESTING
CUSTOMER DEMONSTRATION FLIGHTS MULTIPLE AIRWORTH ICATES for RESTRICTED CATEGORY ARORAFT (Check ABOVE Tearied Operator" and Standed" ar Limind" as applcadi) D 10 CURRENT AIRWORTHINESS CERTIFICATE to RETAIN DATE of ISSUANCE A. REGISTERED OWNER (A a) IF DEALER, CHECK HERE
NAME ADDRESS I OWNER' S CERTIFICATION EL AIRORA-T CERTIFICHTION EASTS NORER ANd NET SPECIFICATION OR TYPE CERTIFICATE DATA SHEET (GH No. and AIRWORTHINESS DIRECTIVE: with and give the number of the led AD SLIPP
SUPPLEMENTAL TYPE CERTIF
RESERVED C. AIRORAFT MAINTENANCE RECORDS MAINTENANCE RECORDS ARE IN TOTAL AIRFRAME HOURS EXPERIMENTAL ONLY (Est ho COMPLIANCE WITH APPLICABLE 14 OFR
REQUIREMENTS D. CERTIFICATION - I hereby certty that I am the registered owner (or his agent) of the aircraft described above, that the aircraft is registered with the Federal Atation Administration In accordance with Title 49 of the United States Code 44101 et sea. and applicable Federal Aviation Regulat ons, and that the aircraft has been inspected and is airworthy and eligible for the airworthiness certificate requested.
DATE OF APPLICATION NAME AND TITLE /Print ar pe SIGNATURE AGENCY EPIFICATION THE NECRAFT DESCE BED ABOVE LAS BEEN SPECTED AND FOUR TIRCATED MECHANIC eaten CP RICATED REPAR STATION (MON No.) 14 OFF. part 121 CERTIFICATE HOLDER (Catic ate No.) AIRORAFT MANUFACTURER. (GH CERTIFICATED MECHANIC (Cation No.) (CERTIFICATED FORETON REPAIR STATION (CACH No.)
IN. DATE as entered in logbook PRINT NAME and TITLE of INSPECTOR as entered in logbook TCheck A22 applicacle Slock fare A and 07 A. I find that the aircraft described in Bection I or VII THE DERTIFICATE REQUESTED DENIAL LETTER ISSILED REPRESENTATIVE CERTIFICATION B. Inspection for a special fight permit under Section meets / does not meet requirements for FAA INSPECTOR AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHINESS CERTIFICATE FAA DESIGNEE V.FAA VIl was conducted by: CERTIFICATE HOLDER UNDER 14 CFR. part 65 • 14 OFR. part 121 OR 135 14 CFF. part 14 DATE FAA OFFICE FAM INSPECTOR 3 SIGNATI E or DESIONEE S FAA INSPECTOR S CERTIFICATION FILE REVIEW SIGNATUR SIGNATURE AND NO.
FAA For 8130-6 (Xx/0) SUPERSEDES PREVIOUO EDITION Page 1 of 2 A-3