Maintenance and Manufacturing Staff Instructions, MSI 69, Appendix A


Appendix A - Acknowledgment of Receipt

City, Province
Postal Code

Date

Name/Address
City, Province
Postal Code

Dear Sir/Madam,

Please find enclosed a Department of Transport Inspection Stamp, Number [Enter Stamp Number ] , and embossing seal issued for your exclusive use when issuing Certificates of Airworthiness, Special Certificates of Airworthiness - Restricted or Export Airworthiness Certificates.
These items are the property of the Minister of Transport and are to be returned immediately upon request by the Minister, or upon your ceasing to exercise your delegation of authority. You are responsible for keeping these items in a secure place. Please sign in the appropriate space below to acknowledge receipt and return a signed copy of this form to the Department of Transport at the above address.
Yours truly,

[ Enter Name ]
Regional Manager,
Aircraft Maintenance & Manufacturing

This is to acknowledge receipt of Department of Transport Inspection Stamp [ Enter Stamp Number ], and Embossing Seal.

MD-P Signature: _________________________ Date: ________________________

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