Appendix XI EASA Form 65 – Letter of Agreement for production without a production organisation approval — Annex I, Initial Airworthiness

AppendixAppendix

Appendix XIEASA Form 65 – Letter of Agreement for production without a production organisation approval

Appendix XI

Letter of agreement for production without a production organisation approval — EASA Form 65

Letter of agreement referred to in Subpart F of Annex I (Part 21)

[MEMBER STATE] () A Member of the European Union () LETTER OF AGREEMENT FOR PRODUCTION WITHOUT A PRODUCTION ORGANISATION APPROVAL [NAME OF THE APPLICANT] [TRADE NAME (if different from the name of the applicant)] [FULL POSTAL ADDRESS OF THE APPLICANT] Date (day, month, year) Reference: [MEMBER STATE CODE ()].21F.XXXX Dear Mr/Ms [name of the applicant], your production inspection system has been evaluated and found to be in compliance with Section A, Subpart A and Subpart F of Annex I (Part 21) to Commission Regulation (EU) No 748/2012. Therefore, subject to the conditions specified below, we agree that the showing of conformity of the products, parts, appliances, control and monitoring units and control and monitoring unit components mentioned below may be performed according to Section A of Subpart F of Annex I (Part 21) to Commission Regulation (EU) No 748/2012. No of Units P/N S/N AIRCRAFT PARTS The following conditions are applicable to this letter of agreement: (1) It is valid while [company name] remains in compliance with Section A Subpart A and Subpart F of Annex I (Part 21) to Commission Regulation (EU) No 748/2012. (2) It requires compliance with the procedures specified in [company name] manual reference/issue date......................................................................................................................... (3) It terminates on ……………………………………………………………………………………………………………….. (4) The statement of conformity issued by [company name] under point 21.A.130 of Commission Regulation (EU) No 748/2012 shall be validated by the issuing authority of this letter of agreement in accordance with the procedure...... of the referenced manual. (5) [company name] shall immediately notify the issuing authority of this letter of agreement of any changes to the production inspection system that may affect the inspection, conformity or airworthiness of the products, parts, control and monitoring units and control and monitoring unit components listed in this letter of agreement. For the competent authority: [COMPETENT AUTHORITY IDENTIFICATION () (**)] Date and Signature
EASA Form 65 – Issue 4 () Or 'EASA', if EASA is the competent authority. (*) Delete for third countries.

[MEMBER STATE] (*) A Member of the European Union (**) LETTER OF AGREEMENT FOR PRODUCTION WITHOUT A PRODUCTION ORGANISATION APPROVAL [NAME OF THE APPLICANT] [TRADE NAME (if different from the name of the applicant)] [FULL POSTAL ADDRESS OF THE APPLICANT] Date (day, month, year) Reference: [MEMBER STATE CODE (**)].21F.XXXX Dear Mr/Ms [name of the applicant], your production inspection system has been evaluated and found to be in compliance with Section A, Subpart A and Subpart F of Annex I (Part 21) to Commission Regulation (EU) No 748/2012. Therefore, subject to the conditions specified below, we agree that the showing of conformity of the products, parts, appliances, control and monitoring units and control and monitoring unit components mentioned below may be performed according to Section A of Subpart F of Annex I (Part 21) to Commission Regulation (EU) No 748/2012. No of Units P/N S/N AIRCRAFT PARTS The following conditions are applicable to this letter of agreement: (1) It is valid while [company name] remains in compliance with Section A Subpart A and Subpart F of Annex I (Part 21) to Commission Regulation (EU) No 748/2012. (2) It requires compliance with the procedures specified in [company name] manual reference/issue date......................................................................................................................... (3) It terminates on ……………………………………………………………………………………………………………….. (4) The statement of conformity issued by [company name] under point 21.A.130 of Commission Regulation (EU) No 748/2012 shall be validated by the issuing authority of this letter of agreement in accordance with the procedure...... of the referenced manual. (5) [company name] shall immediately notify the issuing authority of this letter of agreement of any changes to the production inspection system that may affect the inspection, conformity or airworthiness of the products, parts, control and monitoring units and control and monitoring unit components listed in this letter of agreement. For the competent authority: [COMPETENT AUTHORITY IDENTIFICATION (*) (**)] Date and Signature

EASA Form 65 – Issue 4 (*) Or 'EASA', if EASA is the competent authority. (**) Delete for third countries.

APPENDIX · Appendix XI — Regulation (EU) No 748/2012 · Regulation (EU) 2024/1108 · Initial Airworthiness Easy Access Rules · EAR revision 27 Nov 2025