Accountable Executive

Compliance Statement

MPS 163

I, _______________________________ Certificate Holder for

_________________________________ hereby appoint

_________________________________as Accountable Executive

I, ________________________ _______accept the responsibilities of this position for (name, position title and signature)

_________________________________ (name on certificate(s))

for the following certificates:

Flight Training Flight Training Unit Manufacturer Unit Manufacturer

Approved MaintenanceApproved Maintenance Organization Air OperatorOrganization Air Operator

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