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Aircraft Maintenance Programme - MATRIX
NOTE: For aircraft not used in commercial operations and not subject to have a mandatory Reliability program
CAMO/Owner Applying for approval of a Maintenance Program, for fixed wing aircraft & single engine helicopters
(with a MTOM below 5700 kg. for non commercial use) according to (EC) No. 2042/2003, Part M, M.A. 302 &
AMC M.A. 302, incl. Appendix I to AMC M.A. 302.
Document Reference:
Document issue number:
CAMO approval no.
Aircraft owner name:
Date of Issue:
AMC App. 1 - 1.1.3
Address:
Contact details:
AMC App. 1 - 1.1.2
AMC App. 1 - 1.1.1
AMC App. 1 – 1.1.12
Aircraft Registration(s):
Aircraft year of manufacture:
Engine Manufacturer:
Aircraft Manufacturer:
Engine Type/Model:
Aircraft Type/Model:
Propeller/Manufacturer:
Serial. No.:
Propeller Type/Model:
AMC App. 1 - 1.1.1
Yearly anticipated utilization:
Aircraft current FH / FC:
Flight Hours:
Cycles:
Flight Hours:
Cycles:
AMC App. 1 - 1.1.6
Type of operation
VFR
- Night VFR
AMC App. 1 - 1.1.6
- IFR
Applicable BL1-1 requirement:
Afsnit 5
,6
eller 7
1a. List references to the used:
Basic Maintenance Program from Type certificate / STC / ETSO holders in Table 1, a)
Done
AMC App. 1 - 2.1
1b.List and/or refer to list of details of:
Basic Maintenance Program from Type certificate / STC / ETSO holders details in Table 1, b).
Done
AMC App. 1 - 1.1.10, 1.1.11 & 1.1.16
1c.Life limited and flight critical components:
Are there any Life Limited, Hard Time or any Flight Critical Components which demands
maintenance?
These must be stated and specified in Table 1, c).
AMC App. 1 - 1.1.16
1d.Repetitive Airworthiness directives (AD’s):
Are there any applicable AD’s (State of design AD, EASA AD or State of registry AD) which is
repetitive?
These must be stated and specified in Table 1, d).
AMC App. 1 - 1.1.17
162 bilag 1 AMP Matrix below 5700kg – Non Commercial. Rev. 2010-11-11
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Yes
No
Yes
No
Aircraft Registration(s) :
Doc. Reference & revision:
2a. Additional Maintenance Programs and/or changes to Maintenance Instructions:
Are there any additional Maintenance Programs, such as, Aging Aircraft program 1.1.12, Structure
Maintenance program1.1.13 & 1.1.15?
These instructions must be listed and specified in Table 2, a).
Yes
No
AMC App. 1 – 1.1.12 & 1.1.13 & 1.1.15
2b. Additional Maintenance Procedures (Operational):
Are there any additional Maintenance Procedures related to the type of operation, including pre-flight
inspection or procedures if applicable?
These procedures must be listed and specified in Table 2, b).
2c. Variations/Deviations from Type Certificate:
Are there any additional Maintenance on the aircraft due to equipment or alterations “Supplementary
Type Certificate” (STC), or any other data deviating from the Type Certificate?
These variations must be stated and specified in Table 2, c).
Yes
No
Yes
No
AMC App. 1 - 1.1.10, 1.1.11 & 1.1.16
2d. Repairs:
Are there any tasks, such as inspections and / or any additional Maintenance Program related to
repairs performed on the aircraft?
These repairs must be stated and specified in Table 2, d).
Yes
No
AMC App. 1 - 1.1.3
2e. Additional recurrent inspections:
Are there any recurrent inspections other than stated in the basic maintenance documents?
Recurrent SB, SL or other requirements stated by DCAA must be stated in Table 2, e).
Yes
No
AMC App. 1 - 1.1.17
2f. National (State of registry) Requirements
Are there any national requirements (such as airspeed/altimeter checks, compass swing etc.)?
These requirements must be listed in Table 2, f).
Yes
No
AMC App. 1 - 1.1.17
2g. National (State of registry) deviations from maintenance on engines, propellers and
components:
Are there any national deviations to the Type Certificate holders recommended time between
overhaul (TBO) / Corrosion inspection / Engine TBO extension?
Reference to DCAA document and method of compliance must be listed in Table 2, g).
Yes
No
AMC App. 1 - 1.1.17
3. Maintenance performed by Pilot/Owner (Only applicable for A/C with MTOM below 2730 kg.):
Pilot/Owner Maintenance (Ref. Part M, Appendix VIII and related AMC):
These Maintenance tasks must be listed in Table 3 and approved by contracted CAMO or DCAA.
The name, License reference and Task competence, for the Pilot/Owner performing approved
Pilot/owner maintenance tasks, must be listed in Table 3.
Yes
N/A
AMC.M.B.301(b)5.
4. Maintenance Performed acc. to Part M.A.801 (b)2, (see Appendix VII for limitations):
Maintenance performed by a Part 66 certified person with appropriate type rating.
These Maintenance tasks (incl. any Pilot/Owner Maintenance tasks) must be listed in Table 4 and
approved by contracted CAMO or DCAA.
The name, License reference and Task competence, for the Part 66 AML holder performing approved
maintenance tasks, must be listed in Table 4.
Yes
N/A
AMC.M.B.301(b)5.
Permitted variations to Maintenance:
Should the need for a variation of the Maintenance Program arise, the variation must be approved by the DCAA.
In case of no Tolerances from TC-holder or STC-holder, DCAA, BL 1-1 apply.
AMC App. 1 - 1.1.7
CAMO Revision of the Maintenance Program:
Revisions approved by CAMO (CAMO with indirect approval according to M.A. 302 (e)). Copy of the CAMO
approved maintenance program shall be send to the DCAA within 10 days.
List of revision status, see Table 5
M.A.302(c)
Owner Revision of the Maintenance Program:
Any revisions to the Maintenance Program must be approved by DCAA
List of revision status, see Table 5
M.A.302(b)
Review of the Maintenance Program (Ref. M.A.302(f) and Appendix 1 to AMC M.A.302 para. 5):
Reviews must be added to the list of Periodic Control & Annual review (Table 6).
As a minimum, an annual review of the maintenance program must be conducted.
AMC App. 1 - 1.1.4
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Aircraft Registration(s) :
CAMO approval number:
Owner Statement:
Doc. Reference & revision:
Statement
a) The Aircraft named above is maintained according to this approved maintenance program and (EC)
No.2042/2003 Part-M.
b) All CRS are performed acc. to (EC) No.2042/2003 Part-M.
c) There is an approved file system for all inspection documents, discrepancies and maintenance documents.
d) The maintenance program is based on maintenance data from the TC holder and other applicable
instructions.
e) The maintenance performed on the Aircraft and its components / equipment is performed in accordance with
latest revision of the above given instructions.
f) Aircraft utilization is with in the recommendations given in the maintenance data.
g) The CAMO/Owner will review all maintenance data and other service instructions for revision status on a
regular basis and verify the review in Table 6.
h) The complete maintenance program will as a minimum, be annually reviewed.
i) Apply all methods and standards given in the maintenance data.
j) Deviations from the maintenance data must be stated in the Approved Maintenance Program.
k) All changes in aircraft Utilization, outside the basis of which the Maintenance Program was designed, must
result in a revision of the maintenance program approved by a CAMO or the DCAA.
Owner name / Signature / Date: ____________________________________________
CAMO NPH name / Signature / Date: ________________________________________
AMC App. 1 - 1.1.4 & 1.1.19
To be filled in by CAMO with indirect approval according to M.A. 302 (c):
This Aircraft Maintenance Program is approved by a CAMO
Copy sent to DCAA - Yes
CAMO Name & Signature:
Date:
Stamp:
To be filled in by DCAA (if the CAMO doesn’t have a indirect approval according to M.A. 302 (c)):
DCAA Name & Signature:
Date:
Stamp:
162 bilag 1 AMP Matrix below 5700kg – Non Commercial. Rev. 2010-11-11
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TABLE 1
Reference to TC holders maintenance planning document and/or recommended maintenance programme and
List of / reference to list of the tasks and the periods (intervals/frequencies) at which each part of the
 aircraft, engines, APU’s, propellers, components, accessories, equipment, instruments, electrical and
radio apparatus, together with the associated systems and installations should be inspected and
 the periods at which components should be checked, cleaned, lubricated, replenished, adjusted, tested,
overhauled and replaced and
 any repetitive maintenance AD’s
AMC App. 1 - 1.1.10 & 1.1.11, 1.1.16 & 2.1
Aircraft Registration(s) :
Doc. Reference & revision:
a)
Title
Aircraft:
Insert as many lines as needed.
Chapter
Rev. Status*
Reference (Rev. & date)
Interval/frequencies
Engine:
Insert as many lines as needed.
Propeller:
Insert as many lines as needed.
Components:
Insert as many lines as needed.
*Dokument revision status ved tidspunkt for ansøgning
Task & Type and degree of inspection /
maintenance
b) Basic Maintenance program (Ref. Table 1, a)
Insert as many lines as needed.
c)Life limited and flight critical components:
Insert as many lines as needed.
d) Repetitive Airworthiness directives (AD’s):
Insert as many lines as needed.
162 bilag 1 AMP Matrix below 5700kg – Non Commercial. Rev. 2010-11-11
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TABLE 2
Additional and/or changes maintenance instructions , Variations, Deviations, Repairs, National
requirements & Other recurrent jobs
Aircraft Registration(s) :
Doc. Reference & revision:
Task
Reference ( rev & date)
a) Additional and/or changes maintenance instructions (Maintenance):
Insert as many lines as needed.
Interval
b) Additional maintenance procedures (Operational):
Insert as many lines as needed.
c) Variations / Deviations from Type certificate:
Insert as many lines as needed.
d) Repairs:
Insert as many lines as needed.
e) Recurrent inspections other than stated in the basic maintenance document:
Insert as many lines as needed.
f) National Requirements (State of registry):
Insert as many lines as needed.
g) State of registry deviations from maintenance on engines and components:
Insert as many lines as needed.
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TABLE 3
Pilot – Owner Maintenance (PO)
Aircraft Registration(s) :
Doc. Reference & revision:
Task description
Insert lines as needed.
Maint. Task number
Reference ( Rev. & date)
Name
Insert lines as needed.
License ref.:
Maint. Task no. Competence
Interval
DCAA (if not CAMO supported)/CAMO has found Pilot/Owner competent to perform tasks referred to in
Table 3:
DCAA Name & Signature:
Date:
Stamp:
AMC.M.B.301(b)5
TABLE 4
AML Holder Maintenance (AML)
Aircraft Registration(s) :
Doc. Reference & revision:
Task description
Insert lines as needed.
Maint. Task number
Reference (Rev. & date)
AML Holder (Name)
License ref.:
Maint. Task no. Competence
Interval
DCAA (if not CAMO supported)/CAMO has found AML holder competent to perform tasks referred to in
Table 4:
DCAA Name & Signature:
Date:
Stamp:
AMC.M.B.301(b)5
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TABLE 5
Maintenance Program Revision
Aircraft Registration(s) :
Rev. No.
1.1.5 & 1.1.8
Doc. Reference & revision:
Revision highlight & List of Effective Pages (LEP)
162 bilag 1 AMP Matrix below 5700kg – Non Commercial. Rev. 2010-11-11
Date & Signature
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TABLE 6
Periodic Control & Annual review
Aircraft Registration(s) :
Doc. Reference & revision:
Once a year check revisions status on the maintenance data referred to in table 1 and 2 to assure the validity of
the maintenance program. As a minimum, an annual review of the maintenance program must be conducted.
Changes must be stated here. Escalation / Descalation must be based on a maintenance program review.
Controlled items
Datum & Signature
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