Form FAA-8110-12 Application for Type Certificate, Production Certificate

INFORMATION FOR APPLICANT
U.S. Department
of Transportation
Federal Aviation
Administration

APPLICATION FOR TYPE CERTIFICATE, PRODUCTION CERTIFICATE,
OR SUPPLEMENTAL TYPE CERTIFICATE
Paperwork Reduction Act Statement:
A federal agency may not conduct or sponsor, and a person is not required to respond to,
nor shall a person be subject to a penalty for failure to comply with a collection of information
subject to the requirements of the Paperwork Reduction Act unless that collection of
information displays a currently valid OMB Control Number. The OMB Control Number for
this information collection is 2120-0018. Public reporting for this collection of information is
estimated to be approximately 48 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed,
completing and reviewing the collection of information. All responses to this collection of
information are required to obtain or retain a benefit under the authority of 49 U.S.C. 44702
as implemented by 14 CFR part 21. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden
to the FAA at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information
Collection Clearance Officer, ASP-110.

Tear off this cover sheet before submitting this form.

FAA Form 8110-12(6/14) Supersedes Previous Edition

INSTRUCTIONS FOR COMPLETION OF FAA FORM 8110-12,
APPLICATION FOR TC, AMENDED TC, PC, STC, OR AMENDED STC
FAA Form 8110-12 is used for application for a TC, Amended TC, PC, STC, or Amended STC.
Application for a TC and a PC may be made at the same time if desired. Only the appropriate
blocks, as follows, need to be filled out for each type of certificate.
Blocks 1, 2, 3, 4, 5, 6, and 8 for a TC or Amended TC;
Blocks 1, 2, 3, 5, and 8 for a PC;
Blocks 1, 2, 3, 4, 7, and 8 for an STC or Amended STC.
Block 1.

Enter the name of the party, corporation or organization to whom the TC, Amended
TC, PC, STC, or Amended STC will be issued. The name will appear on the certificate
exactly as it is entered here.
NOTE: Only the TC holder can either apply to amend the original TC or apply
for an STC. If a person is not the TC holder, that person must apply for an STC
(Refer to 14 CFR 21.113). Also, only STC holders can apply to amend their own
STC.

Block 2.

Check appropriate block.

Block 3.

Check appropriate block.

Block 4.

Enter the address of the party, corporation or organization to whom the TC, Amended
TC, PC, STC, or Amended STC will be issued.
NOTE: A post office box will not be accepted.

Block 5.

Complete this block if application is for a TC or Amended TC. Leave blank if
application is for a PC, STC, or Amended STC.

Block 6.

Complete parts a, b, and c of this block if application is for a PC. Give PC number if
application is for an addition to a PC. Leave blank if application is for an original PC.
Give TC/STC number if known at time of application, otherwise leave blank. Refer to
14 CFR §§ 21.45 and 21.119.
NOTE: A PC is normally not required for production of parts for an STC, they
are usually manufactured under a PMA authorization.

Block 7.

Complete parts a, b, c, and d if application is for an STC.

Block 8.

Obtain the signature of the certifying official. The certifying official must be the
holder or the person duly authorized to sign for the holder, company, or corporation.

U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL AVIATION ADMINISTRATION

FORM APPROVED
OMB No. 2120-0018
EXP DATE: 9/30/2017

APPLICATION FOR TYPE CERTIFICATE, PRODUCTION CERTIFICATE, OR SUPPLEMENTAL TYPE
CERTIFICATE
1. Name Of Applicant

2. Application made for :

3. Product Involved

Type Certificate
Supplemental Type Certificate

Production Certificate

Aircraft

Amended Type Certificate

Engine
Propeller

Amended Supplemental Type Certificate
4. Address

5.

b.

City

State

c. Zip Code

TYPE CERTIFICATE (Complete item 5a below)
a. Model designation(s) (All models listed are to be completely described in the required technical data, including drawings representing the design, material, specifications, construction, and
performance of the aircraft, aircraft engine, propeller which is the subject of this application.)

6. PRODUCTION CERTIFICATE (Complete items 6a-c below. Submit with this form, in manual form, one copy
of quality control data or changes thereto covering new products, as required by applicable FAR.)
a. Factory address (if different from above)

b. Application is for

P.C. No.

New production certificate
Additions to production
Certificate (Give P.C. No.)
T.C./S.T.C. No.
c. Applicant is holder of or a licensee under a Type Certificate or a Supplemental Type Certificate
(Attach evidence of licensing agreement and give certificate number)

7. SUPPLEMENTAL TYPE CERTIFICATE (Complete items 7a-d below)
a. Make and model designation of product to be modified

b. Description of modification

c. Will data be available for sale or release to other persons?
Yes

d. Will parts be manufactured for sale? (Ref. FAR 21.303)

No

No

Yes

8. CERTIFICATION - I certify that the above statements are true.
Signature of certifying official

Title

FAA Form 8110-12 (6/14) SUPERSEDES PREVIOUS EDITION

Date