voluntary individual vehicle approval application for a non

Document Sample
voluntary individual vehicle approval application for a non Powered By Docstoc
					                                                                                                                 VIVA 1
                                                                                                                   Voluntar y IVA




    APPLICATION FOR VOLUNTARY (NON STATUTORY) INDIVIDUAL VEHICLE APPROVAL
                       M1 & N1 CATEGORY VEHICLES ONLY

                                                     OFFICIAL USE ONLY
 Station                        MR                                                                 Reg. or
 Instruction                 Number                                                              Z Number

          Before completing this form, you MUST READ and understand the information provided in the GUIDANCE NOTES.
                             Please do not submit the guidance notes with the application.
            FAILURE TO COMPLETE THE FORM ACCURATELY OR IN FULL COULD RESULT IN DELAYS

1. OWNER AND PRESENTER CONTACT DETAILS                                                           (See note 1 in Guidance Notes)

          PRESENTER (if different from owner)                                                OWNER
Full   Title                                                       Full   Title
Name                                                               Name
Address :                                                          Address :



Postcode :                                                         Postcode :
Contact Tel No :                                                   Contact Tel No :
E-mail                                                             E-mail
                                                                          Please tick/complete the appropriate boxes below ▼
2. APPOINTMENT AND PAYMENT DETAILS                                                            (See note 2 in Guidance Notes)

   PLEASE NOTE : DATE & TIME OF YOUR VOLUNTARY IVA TEST WILL BE ALLOCATED BY YOUR
                   CHOSEN TEST STATION AND NOT BY VOSA SWANSEA

2a. Which Test Station would you prefer?*                                                        or
*Note : Only specific sites can test vehicles having an unladen weight over 3500kgs and/or a wheelbase exceeding 4.0 metres.

2b. When would you like the test?                DAY                               AM                 PM                ASAP
2c. Payment Method : You will be contacted by telephone for Credit/Debit card payments
                Postal        Credit or                              Cash                                  Pre-funded
 Cheque
                Order         Debit card        (ONLY when application is presented in person)             Account

                                                                      Please tick/complete the appropriate boxes below ▼
3. VEHICLE DETAILS                                                                        (See note 3 in Guidance Notes)
3a. Vehicle Registration Number or if not registered, Vehicle Identification (chassis) Number (VIN).



3b. Vehicle Make and full model description
3c. What is the date of manufacture?                        Month                                             Year
3d. Has the vehicle been previously registered                                  YES                           NO
    (in any country)?
    If ‘YES’ please confirm the date of first registration ►           dd/mm/yyyy
                                                                                                               Continued overleaf ►


VIVA 1 (VOSA 754)                                                 1                                                     v4.0 Dec 2012
                                                                      OFFICIAL USE ONLY            REG / Z NUMBER

                                                                               Please tick/complete the appropriate boxes below ▼
3. VEHICLE DETAILS cont…                                                                           (See note 3 in Guidance Notes)

3e. Has the vehicle been imported into the UK?                                            YES                          NO
     If ‘YES’ what country has the vehicle come from? ►

3f. Is the vehicle a passenger or goods?                                                 Passenger                             Goods

3g. What is the body type of the vehicle e.g. 3 door hatch, saloon, estate?

3h. Is the vehicle : Petrol                  Diesel             Gas   Hydrogen            Other (please state)
3i. What is the engine size?                                                                       3
                                                                               (Please confirm ‘cm ’ of engine)                        cm3

3j. Is the engine :                                         Turbocharged?                    Non Turbocharged?
3k. Is the gear box :                           Manual?                        Automatic?
3l. If a registered vehicle, has it been modified since it was first registered?
                                                                                    YES                                           NO
     If ‘YES’, please give brief details of the modification ▼




3m. Does the vehicle have anti-lock brakes (ABS)?                                        YES                        NO
3n. How many designated seating positions does the vehicle have including the driver’s?
3o. If the vehicle is a 4x4, is it                  Permanent 4x4?                                     Selective 4x4?
3p. What is the maximum design road speed of the vehicle?                                                                  mph
      (DO NOT take this figure from the speedometer – see note 3 in Guidance Notes)

3q. What is the engine maximum power and the engine speed                                                 /                kW/rpm
    at which it is obtained?                                                                              or
     (DO NOT take this figure from the rev counter – see note 3 in Guidance Notes)                        /                bhp/rpm
3r. What are the design weights of the vehicle? *
       * Refer to the weights plate on the vehicle, or the vehicle handbook or contact the manufacturer for this information.
  Axle 1                  Axle 2                     Axle 3            Gross                   Train               Towable Mass
 lbs / kgs               lbs / kgs                  lbs / kgs         lbs / kgs              lbs / kgs               lbs / kgs
3s. If the weights were taken from a converters plate, please provide original manufacturer’s weights
 Axle 1                   Axle 2                     Axle 3            Gross                   Train               Towable Mass
Lbs / kgs                lbs / kgs                  lbs / kgs         lbs / kgs              lbs / kgs               lbs / kgs

3t. Is the vehicle fitted with:                       Immobiliser*                Alarm*                      Not fitted
     If you have ticked either of the above indicating one is fitted, please refer to the Guidance Notes for information on what
     evidence of Compliance you need to provide at the time of test.

4. VEHICLE CLASS                                                                                           (See note 4 in Guidance Notes)

4a. Please indicate the class that you require the vehicle to be tested to. Note : the relevant standards
    appropriate to the class of vehicle will be taken into account during the examination.
     For the full description of the classes, please refer to the Voluntary IVA Guidance notes.
 N           Left Hand Drive         Go to part 8                      L          A vehicle manufactured in very low volume       Go to part 8

                                                                                  A vehicle not meeting any other category        Go to parts
 P           Personal Import         Go to part 8                      R          requiring a Normal IVA                           5, 6 7 & 8

 A           Amateur Built           Go to part 8                      T          Armoured Vehicle *                              Go to part 8

 S           Rebuilt Vehicle         Go to part 8                      M          Hearse, Motor Ambulance or Caravan       *      Go to part 8

 S           A vehicle built by a person in the business of building vehicles, using parts of a vehicle registered in the UK.     Go to part 8



VIVA 1 (VOSA 754)                                                          2                                                     v4.0 Dec 2012
                                                               OFFICIAL USE ONLY          REG / Z NUMBER


4. VEHICLE CLASS cont…                                                                          (See note 4 in Guidance Notes)

If your vehicle is also a wheelchair accessible vehicle*, please indicate here ►
*Wheelchair accessible vehicle means a passenger vehicle constructed or converted specifically so that they
accommodate one or more person(s) seated in their wheelchair(s) when travelling on the road.

                                                                         Please tick/complete the appropriate boxes below ▼
5. CLASS ‘R’ ONLY                                                                            (See note 5 in Guidance Notes)
5a. Does the vehicle display a European Type Approval number
                                                                                          YES                 NO
    on the manufacturer’s plate?
    If ‘YES’ please write the Type Approval Number here ►
   If ‘YES’ what is the recorded mileage (including the mileage before
   any modification)? ►
                                                                                                               miles / km

5b. Has the vehicle had a ‘One-Off’ Test?                                                 YES                 NO
    (Please refer to the Guidance Notes for more information)
    If ‘YES’ please write the Test Report Number here (if known) ►

5c. Is the vehicle to be tested against an existing Model Report?                         YES                 NO
    If ‘YES’ please write the Model Report Number here (if known) ►

                                                                         Please tick/complete the appropriate boxes below ▼
6. CONVERTED VEHICLES ONLY                                                                   (See note 6 in Guidance Notes)
6. Is your vehicle now a passenger vehicle, with no more than 8 passenger seats that has been :
    a. converted into a ‘limousine’ by increasing the number of
                                                                      YES              NO
        seating positions?
    b. converted from a passenger vehicle that had more than 8
                                                                      YES              NO
        passenger seats?
    c. converted from a goods vehicle (this includes wheelchair
                                                                      YES              NO
        accessible vehicles)?
    d. converted from a goods vehicle that has a design weight
                                                                      YES              NO
        of 1500kgs or more?
        Please Note : If you have ticked ‘YES’ to ‘d’ above please confirm the
        original design weight of the vehicle before the conversion ►
                                                                                                                        kgs

   e. adapted for a person with a disability?                                              YES                 NO
   f.   adapted to accommodate one or more wheelchairs?                                    YES                 NO
        If ‘YES’, please state maximum number of wheelchair positions ►

   g. manufactured on or after 1st October 2003?                                           YES                 NO
        Please Note : If you have ticked ‘YES’ to both ‘d’ and ‘e’ above, please
                                                                                                                        kgs
        confirm the design weight of the vehicle ►
        If ‘YES’ to both ‘d’ and ‘f’, does the vehicle also have a seat reference point
        (of the lowest front seat) of more than 700mm above the ground? ►                  YES                 NO


                                                                                                           Continued overleaf ►




VIVA 1 (VOSA 754)                                                    3                                             v4.0 Dec 2012
                                                           OFFICIAL USE ONLY         REG / Z NUMBER


                                                                 Please tick/complete the relevant boxes below to
7. DOCUMENT CHECKLIST                                            indicate what you have enclosed ▼
R – A vehicle not meeting any other category : Please refer to the Guidance Notes for this category.
 Japanese Export/             Manufacturer                                    National Type                   Other
                                                      Certificate of
   De-registration                letter of                                        Approval            (please state
                                                       Conformity
        certificate            Compliance                                         certificate      using box below)
Other documents enclosed :




8. DATA PROTECTION, DECLARATION AND SIGNATURE

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 the Information Charter available from VOSA’s website :
                                                 www.dft.gov.uk/vosa
DECLARATION – I confirm that, as far as I know, all statements in this application are true. I agree to use
the Model Report procedure on the conditions that apply to the compliance check arrangements described
in the Guidance Notes of this form.


Signature :                                                                               Date :      /       /


Print Full Name :



   Please send all fully completed application forms, supporting documents and your payment to :

    in the case of classes ‘R’, ‘W’, limousines and modified vehicles to :
       APPROVAL SECTION, VOSA, ELLIPSE, PADLEY ROAD, SWANSEA, SA1 8AN
    or in the case of any other category requiring a ‘Basic’ IVA, to the test location of your choice.
                                          Further information can be found on –
                                         www.gov.uk/vehicleapproval
                                                or via our
                      ENQUIRY LINE – 0300 123 9000 or by email to enquiries@vosa.gov.uk.




VIVA 1 (VOSA 754)                                                4                                            v4.0 Dec 2012

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:0
posted:4/3/2013
language:Korean
pages:4