PART 217 T100(f) Certification

PDF

OMB NO: 2138-0040

EXPIRATION DATE: 11/30/2026

REQUIREMENTS

RECORD DESCRIPTION/INSTRUCTIONS: T100(f) Certification

A certification statement is required identifying an appropriate official of the reporting carrier. The certification statement will read:

Carrier Name:
Address:
Homeland:
(Homeland is the name of the country under the laws of which air carrier organized.)
Carrier Code:
Report Date (Year/Month):

I, the undersigned, do certify that this report has been prepared under my direction in accordance with the regulations in 14CFR Part 217. I affirm that, to the best of my knowledge and belief, this is a true, correct and complete report.

Date:

Signature:

Name (Please Print or Type):
Title:
Telephone Number:
Name of Person Who Prepared Report:
Telephone Number:

E-mail Address:

RECORD FORMAT:

Once signed, the T100(f) Certification must be published as an electronic “portable document format” file format, for uploading to the eSubmit application.

The portable document format file MUST BE indicated when naming the file, by using the letters [PDF] or [pdf] following the file name, as the file name extension. You must have Adobe Reader software downloaded on your computer in order to “save as/print” your document as a ‘pdf’ file.

While the file name is flexible and may be determined by the individual air carrier, the portable document format (pdf) file format is required, as outlined in the rule entitled, Submitting Airline Data via the Internet.

Suggested file name: XXX201003-217T100fCert.pdf