2.

2(/++
IJHK8JKH6B H;F6?H C6DK6B

CLO @OB>PB ?B>J

>IILT>?IB A>J>DB
OBCBO QL
POJ 31+4.+/1
?P
525
PFII TB? &CLOJBA'
?P CO>JB
545 ?P
565 CO>JB
?P ?P
572,1 6.5
?P CO>JB
605
?P
RMMBO PFII >PPBJ?IV
625
RMMBO PFII >PPBJ?IV
&TB?* BUQORABA QBB' QVM ?P
645

RMMBO PFII >PPBJ?IV ?P

665
CLOJBA FKQBO@LPQ>I

CLOJBA FKQBO@LPQ>I
P+/2O

RMMBO PFII P+/3O

>PPBJ?IV
P+/4O
FKQBO@LPQ>I
&OBCBO QL P+/5O
CFDROB / CLO QEB
BCCB@QFSFQFBP' P+/6O
PQR?
P+/7O CO>JB >
CLOJBA
FKQBO@LPQ>I P+0.O FKQBO@LPQ>I >

TB? P+0/O
TB?
ILTBO PFII P+00O PQR? CO>JB >
>PPBJ?IV
P+01O
FKQBO@LPQ>I >
ILTBO >RUFIF>OV P+02O
PFII >PPBJ?IV TB? P+03O
P+04O
CLOJBA FKQBO@LPQ>IP CTA
P+05O

OFDEQ PFAB LKIV

>CQ @>ODL ALLO
ABQ>FI FFF

*%%)(+ 8"""&+($$&&=;#

IVTeZ`_ /1 9``c Ifcc`f_U IecfTefcV 6]]`hRS]V 9R^RXV

<ZXfcV ,+, $IYVVe 0 `W ,,%

0.(1+(,0
6BBEM67B; 96C6=; ,
GTZX ,+0
;1(.3-/1 Ebi ,,*-+,-
<99E 4<44, ;H>BG@ IKHIKB>M9KR * <efoh_]^j q LachU_\f[XW Nbe^ ( JXX g\g_X cTZX Ybe WXgT\_f
 2.2(/++
IJHK8JKH6B H;F6?H C6DK6B

PFII TB?
P@RCC MI>QB &QFQ>KFRJ'
P@RCC MI>QB &QFQ>KFRJ'
@E>KKBI
PQO>M

PFII TB?

>KDIB &PQO>M' OBCBO QL PHFK

>IILT>?IB A>J>DB
POJ 31+..+./
FK?A

J>QBOF>I8 >IRJFKRJ RKIBPP LQEBOTFPB KLQBA

PB@QFLK >+>

KF@HP* DLRDBP*
ELIBP >KA
ABP@OFMQFLK @O>@HP P@O>Q@EBP >KA ABKQP
MRK@QROBP
@LOOLPFLK
TB? F A B D
ILTBO PFII
>PPBJ?IV
>KDIB > @ KLQ MBOJFQQBA KLQ MBOJFQQBA

RMMBO PFII TB? F A B D

>PPBJ?IV
@E>KKBI > @ B E

LRQ?A QBB > @ KLQ MBOJFQQBA KLQ MBOJFQQBA

CO>JB > @ B KLQ MBOJFQQBA

FKQBO@LPQ>I > @ B E

TB? F A B D

PFII TB? F A B D

ILTBO >RU PFII TB? F A B D

>PPBJ?IV
@E>KKBI > @ KLQ MBOJFQQBA KLQ MBOJFQQBA

PQO>M > ? KLQ MBOJFQQBA KLQ MBOJFQQBA

>KDIB > @ KLQ MBOJFQQBA KLQ MBOJFQQBA

@E>KKBI > @ KLQ MBOJFQQBA KLQ MBOJFQQBA

P@RCC MI>QB &QFQ>KFRJ' > @ B G D

>IILT>?IB A>J>DB CLO ABQ>FI FFF *%%+#$ 8"""&+($$&(=;$

IVTeZ`_ /1 9``c Ifcc`f_U IecfTefcV 6]]`hRS]V 9R^RXV

<ZXfcV ,+, $IYVVe 1 `W ,,%

0.(1+(,0
6BBEM67B; 96C6=; ,
GTZX ,+1
;1(.3-/1 Ah_ ,+*-+-+
<99E 4<44, ;H>BG@ IKHIKB>M9KR * <efoh_]^j q LachU_\f[XW Nbe^ ( JXX g\g_X cTZX Ybe WXgT\_f
 2.2(/++
IJHK8JKH6B H;F6?H C6DK6B

KLQBP
+ OBCFKFPE OBTLOHBA >OB>P MBO >JJ 3/+0/ D ELIBP >KA MRK@QROBP >OB MBOJFQQBA RM QL >
AF>JBQBO LC .,03 FK@E, QEB A>J>DB JRPQ ?B
+ OBCBO QL POJ 3/+/.+.0 CLO FKPMB@QFLK >KA
JFKFJRJ LC /,.. FK@E COLJ LQEBO A>J>DB* >
OBJLS>I LC A>J>DB,
> ELIB* LO > M>OQ BADB,
+ KF@HP* DLRDBP* >KA P@O>Q@EBP QE>Q AL KLQ
@IB>K RM QEB A>J>DB >KA CFII QEB ELIB TFQE
MBKBQO>QB >II QEB T>V QEOLRDE @I>A
> OFSBQ >P CLIILTP* CLO >IRJFKRJ >KA
PROC>@BP J>V ?B FDKLOBA, FKPMB@Q
QFQ>KFRJ PQOR@QROBP8
MBKBQO>QFLK ABMQE MBO POJ 3/+/.+.0,
>IRJFKRJ PQOR@QROB8
ZZZZZZZZZZZZZZZZZZ
+ CLO OBTLOHBA >IRJFKRJ PROC>@BP >MMIV >
MOLQB@QFSB >ILAFKB @L>QFKD MBO + FC QEBOB FP >@@BPP LK B>@E PFAB LC QEB
POJ 3/+0.+./, M>OQ* FKPQ>II > PLIFA 0//5+Q1 LO Q2 OFSBQ
+ CLO OBTLOHBA QFQ>KFRJ PROC>@B >MMIV QTL + FC QEBOB FP KL >@@BPP QL QEB ?>@HPFAB LC
@L>QP LC ?JP /.+//* QVMB / MOFJBO, QEB M>OQ* FKPQ>II > ?IFKA OFSBQ TFQE >K
>
>IRJFKRJ PIBBSB, J>HB PROB QEBOB FP
OBJLSB BADB @O>@HP >P PELTK FK ABQ>FIP SFF
>ABNR>QB @IB>O>K@B TEBK VLR AL QEFP,
>KA UF, LQEBO @O>@HP >OB KLQ >IILTBA,
QFQ>KFRJ PQOR@QROB8
ZZZZZZZZZZZZZZZZZZ
? OBJLSB KF@HP* DLRDBP* P@O>Q@EBP* LO
@LOOLPFLK MBO ABQ>FIP S* SF* SFFF* >KA FU, + FC QEBOB FP >ABNR>QB @IB>O>K@B ?BQTBBK
@ QEB PFII PQOR@QROB >KA QEB P@RCC MI>QB*
OBJLSB KF@HP* DLRDBP* P@O>Q@EBP* LO
FKPQ>II > ?IFKA OFSBQ TFQE > JLKBI PIBBSB
@LOOLPFLK MBO ABQ>FIP S* SF* SFF* SFFF*
>KA FU, + CLO LQEBO >OB>P TEBOB QEB PFII PQOR@QROB
FP >AG>@BKQ QL QEB P@RCC MI>QB* AL KLQ
A ?IBKA LRQ BADB A>J>DB >P PELTK FK ABQ>FIP
FKPQ>II > OFSBQ, CFII QEB ELIB TFQE
S* SFF* FU >KA U,
?JP 3+73 PB>I>KQ, BU>JFKB QEB >OB>
?BCLOB QEB ?IBKALRQ LC QEB PROC>@B A>J>DB OBDRI>OIV >KA OBM>FO ?V QEB KBUQ v@v
FP ALKB* JB>PROB QEB ABMQE LC QEB PROC>@B @EB@H,
A>J>DB QL J>HB > PBIB@QFLK LC QEB ?BPQ
E ELIBP >KA MRK@QROBP >OB >IILTBA FK COBB
MOL@BAROB CLO A>J>DB OBJLS>I, QEBK
CI>KDB MBO ABQ>FI UF, ELIBP >KA MRK@QROBP
@LKPFABO QEB CLIILTFKD LMQFLKP8
>OB >IILTBA FK TB? RM QL .,03 J>U AF> >CQBO
+ ?IBKA LRQ QEB PROC>@B A>J>DB >P PELTK FK @IB>KRM MOLSFABA A>J>DB FP /,. FK@E COLJ
ABQ>FI SFF >KA SFFF, >KV LQEBO ELIB* M>OQ BADB* LO LQEBO A>J>DB,
@IB>K RM A>J>DB >KA CFII TFQE > 0//5+Q1 LO
+ AOFII LRQ QEB PROC>@B A>J>DB TFQEFK QEB
0//5+Q2 >IRJFKRJ MOLQORAFKD EB>A OFSBQ,
IFJFQP PMB@FCFBA CLO ELIBP, D E
F OBJLSB BADB @O>@HP >P PELTK FK ABQ>FIP
ZZZZ
KLQB8 QEB A>J>DB J>V KLQ ?B AOFIIBA LRQ
SFF >KA UFF,
>P > ELIB FC ?IBKALRQ LC QEB
A>J>DB E>P ?BBK >QQBJMQBA,
G FC QEB P@RCC MI>QB A>J>DB FP JLOB QE>K QEB
B ABKQP >OB >IILTBA MBO ABQ>FI UFF, >IILT>?IB A>J>DB IFJFQP* QEBK AL QEB
CLIILTFKD8
C ELIBP >KA MRK@QROBP >OB >IILTBA LKIV FK
COBB CI>KDB MBO ABQ>FI UF, OBJLSB QEB A>J>DBA P@RCC MI>QB,
AL > ABQ>FIBA SFPR>I FKPMB@QFLK LC QEB
RKABOIVFKD PQOR@QROB QL @EB@H CLO A>J>DB,
OBCBO QL POJ 3/+/.+.0,
AL > ECB@ FKPMB@QFLK LC QEB RKABOIVFKD
PQOR@QROB FK A>J>DBA >OB> QL @EB@H CLO
A>J>DB, OBCBO QL 515 KAQ M>OQ 4* 3/+..+..*
MOL@BAROB 2 LO 515 KAQ M>OQ 4* 3/+..+..*
MOL@BAROB 01, FC QEBOB FP A>J>DB FK QEB
>OB>* @LKQ>@Q QEB ?LBFKD @LJM>KV,
FKPQ>II QEB P@RCC MI>QB, AL > MBOJ>KBKQ
OBM>FO LO FKPQ>II KBT P@RCC MI>QB ?BCLOB
/3.. CIFDEQ @V@IBP,

*%%+#) 8"""&+($$'$=;%

IVTeZ`_ /1 9``c Ifcc`f_U IecfTefcV 6]]`hRS]V 9R^RXV

<ZXfcV ,+, $IYVVe 4 `W ,,%

0.(1+(,0
6BBEM67B; 96C6=; ,
GTZX ,+4
;1(.3-/1 Ah_ ,+*-+-+
<99E 4<44, ;H>BG@ IKHIKB>M9KR * <efoh_]^j q LachU_\f[XW Nbe^ ( JXX g\g_X cTZX Ybe WXgT\_f
 2.2(/++
IJHK8JKH6B H;F6?H C6DK6B

OLRKA LRQ QL /,.. O JFK

CI>KDB
>KA Q>MBO >P PELTK
TFAQE U

OLRKA LRQ QL /,.. O JFK

>KA Q>MBO >P PELTK
U

Q>MBO
0.U JFK Q>MBO
0.U JFK

J>FKQ>FK J>FKQ>FK
C>PQBKBO C>PQBKBO
BADB J>ODFK BADB
U < ABMQE LC @IB>KRM U < ABMQE LC @IB>KRM J>ODFK
< .,0. J>U < .,0. J>U

OBJLS>I LC A>J>DB LK >K BADB OBJLS>I LC A>J>DB LK >K BADB

ABQ>FI FU ABQ>FI

2 ELIBP J>UFJRJ A>J>DB MBO 4 FK@EBP

>IILTBA, CFII >II ELIBP RM QL
.,03 J>U TFQE >IIRJFKRJ MOLQORAFKD
EB>A OFSBQP &0//5+Q1 LO Q2' FKPQ>IIBA
TBQ TFQE ?JP 3+73 PB>I>KQ
ABKQP JRPQ ?B PJLLQE
>KA COBB COLJ PE>OM
E @OB>PBP* DLRDBP* LO
@O>@HP >KA PELTFKD KL
.,0. E J>U 0A JFK
.,1. E JFK BSFABK@B LC MRIIBA LO
RM QL .,03 ILLPB C>PQBKBOP
FK@E J>U
&ABMQE LC ABKQ' V
COBB
CI>KDB

.,2. E JFK LOFDFK>I

@LKQLRO

TB? LO ZZZZ
KLQB8 KL ELIB A>J>DB >IILTBA
C>PQBKBA FK C>PQBKBA CI>KDBP
> &TFAQE LC JFKLO
CI>KDB
>Z >UFP LC ABKQ'
V
JRPQ KLQ ?B IBPP QE>K 1.
V < .,/03 J>U
>IILT>?IB A>J>DB IFJFQP CLO
ELIBP FK COBB CI>KDB >IILT>?IB A>J>DB CLO ABKQ
ABQ>FI UF ABQ>FI UFF
*"#''# 8"""&+($$'(=;#

IVTeZ`_ /1 9``c Ifcc`f_U IecfTefcV 6]]`hRS]V 9R^RXV

<ZXfcV ,+, $IYVVe ,, `W ,,%

0.(1+(,0
6BBEM67B; 96C6=; ,
GTZX ,,,
;1(.3-/1 Ebi ,,*-+,-
<99E 4<44, ;H>BG@ IKHIKB>M9KR * <efoh_]^j q LachU_\f[XW Nbe^ ( JXX g\g_X cTZX Ybe WXgT\_f
 FOREIGN AIRCRAFT INSPECTION

Name of Airlines inspected: PT. My Indo Airline

Details of Discrepancy: (To be completed by Inspector)

1. No evidence of identification nor monitoring of significant defect – Bulk cargo door cut-
out sill plate found with gouges not recorded.
[ICAO Annex 6 Part I para 4.5.4]

Inspector name: Alvin Leong Date: 17 Dec 2020

Contributing Factor / Root Cause Analysis: (To be completed by Operator)

Tick the most appropriate box for the direct cause of the discrepancy. Contributing causes can also be listed here.
☐ CE 1 - Regulatory Compliance ☐ CE 2 - Approved Operational Documents
☐ CE 3 - Organisation Structure & Management ☐ CE4 - Technical Personnel Qualification &
Training ☐ CE 5 - Departmental Procedures, Guidance & Facilities ☐ CE 6 - Authorisation of
Personnel and Service Providers ☐ CE 7 - Quality System & Safety Management System ☐ CE 8 -
Resolution of Deficiencies and Safety Concerns

Details:

1. Bulk Cargo Door Cut Out Sill Plate Found With Gauges Not Recorded
Check Dimension= Y : 0.118 Inch , A : 1.2 Inch

Immediate / Medium / Long-term Corrective Actions: (To be completed by Operator)

As Ref SRM 53-60-15 Detailed XII, Still Allowable Damage (Y: 0.118 Inch , A : 1.2 Inch)
Limit = Y: 0.125 Inch , A: 30 Inch

Date of completion of corrective action: 17 Dec 2020

Preventive Actions: (To be completed by Operator)

Will be Fix/Replace Scuff Plate on Next ‘C’ Check Inspection

Response person Name: Date:

WIDODO 17 Dec 2020

Title of Response person:

CHIEF INSPECTOR
 REPAIR CHART
ITEM ACTION TAKEN STATUS REPETITIVE ACTIONS
A/C AREA DESCRIPTION CERTIFICATION BASIS (References) STATUS STAMP DATE
NUMBER (Measured / Repaired) (Enter N/A if no repair ins. required)

MR1 0010180D3
DENT AT STA 867 TO REPAIRED IAW SRM ALLOWABLE DAMAGE 1
51 STA 887 BETWEEN EXISTING REPAIR WIDTH : 2.0” SRM 53-00-01 CLOSED N/A POSACE 21/12/16
STR 21R TO 22R DEPTH : 0.032” DETAIL III
LENGTH : 8.0”, A/Y : 54
REPAIRED IAW SRM
DELAM AT RH SRM 57-53-02 REPAIR 2
REF DOC : DR00090
52 OUTBOARD FORE DELAM REPAIRED AND SRM 51-70-10 REPAIR CLOSED N/A AAT 11/02/19
LENGTH: 6”
FLAP GENERAL
WIDTH: 5”
REPAIRED IAW SRM
DELAM AT RH SRM 57-53-02 REPAIR 2
REF DOC : DR00091
53 OUTBOARD AFT DELAM REPAIRED AND SRM 51-70-10 REPAIR CLOSED N/A AAT 11/02/19
LENGTH: 2.5”
FLAP GENERAL
WIDTH: 2’’
MLB 165247
DENT AT AFT ALLOWABLE DAMAGE
REPAIRED IAW
54 CARGO SCUFF DENT REPAIRED SRM 53-60-15 CLOSED N/A MYINDO 17/12/20
SRM 53-60-15
PLATE DETAIL XII
DENT : Y=0.1”, A=1.2”

Page 18 of 20