Application for Initial Certificate(s) of Approval for Individual Road ...

INTERNATIONAL TRANSPORT OF GOODS
UNDER COVER OF TIR CARNETS
Application for Initial Certificate(s) of Approval for Individual Road
Vehicles produced under a Design-Type Authorisation
Authorisation Number : GB/V DT /20
Manufacturers Design-Type Identification:
GV69
Rev. Feb 2009
• To be completed by the applicant.
Part A – Please read the notes overleaf BEFORE completing the form
I, the undersigned, apply for Individual Certificate(s) of Approval for the (state number) road vehicle(s) particulars of
which are given below and which I believe to conform to the specifications and conditions of an authorisation design-type.
1. Particulars of Road Vehicles Office Use Only
Serial Number
Chassis
In Design Type Manufacturer Number
Registration Mark
No. Of Certificate
(GV60) issued
1. Declaration
I undertake to surrender forthwith to the office of issue my Certificate of Approval issued in respect of this application
(a)
(b)
(c)
On expiry of the period of validity of the certificate or,
If the vehicle is permanently taken out of service or,
If there is any change to the essential
I undertake also to inform the office of issue, in writing, of any change of ownership of the vehicle during the validity of
the certificate.
The appropriate remittance of £ is enclosed
Signature (of authorised or person)
Full Name (BLOCK CAPITALS)
Position (E.g. Manager, Secretary)
On behalf of
(Continue overleaf)
Tel
Date
1
VOSA 642 GV69 Revised Feb 2009

Part B – To be completed by authorised manufacturer of the load compartment
I, the undersigned, certify that the correct Authorisation Number and Design-Type Identification has been inserted at the head of this form and
that the load compartments of the road vehicles listed in PART A have been inspected by me, or on my behalf, and conform to the specification
and conditions of that authorised design-type.
Signature
Date
Full Name (BLOCK CAPITALS)
Position (e.g. Manager, Secretary)
On behalf of (authorised manufacturer)
Business Address
Telephone No:
Address where vehicle(s) may be inspected, if necessary; if different from above (see Note 5)
NOTES
1. Applications should be made as early as possible and in any case not less than one month before authorisation is required.
2. The application should be forwarded to the Local Station for your Area in which the vehicles are to be manufactured and be
accompanied by a crossed cheque for the appropriate remittance (see current scale of sees, form GV206) made payable to
‘VOSA’.
3. The applicant (i.e. owner or operator) should complete PART A and the manufacturer of the load compartment must complete
PART B of this form which should be sent to the VOSA District Office which granted the design-type authorisation.
4. A Certificate of Approval will not be issued in respect of a road vehicle subject to registration in the United Kingdom unless the
registration mark is notified.
5. Undercover facilities for the full examination of the vehicle including the roof and underside should be readily available.
Data Protection
The personal information you provide on this form will be used for the purposes of VOSA's statutory functions. It will not be disclosed
to other organisations unless required or permitted by law. For further information, visit our Information Charter available from VOSA's
website: www.vosa.gov.uk
For Official Use Only
I recommend that individual Certificate(s) of Approval be issued to the applicant for the above mentioned road vehicle(s)
Signature
Name (BLOCK CAPITALS)
Grade
The relevant number(s) of the individual certificate(s) of Approval *has/*have been inserted in the
Appropriate column of the table at PART A and the Certificate(s) despatched to the applicant
Issuing Officers Signature
Issuing Officers Name (BLOCK CAPITALS)
Grade
Date
VOSA 642 GV69 Revised Feb 2009
2