Low Emission Zone Vehicle Registration Form by fno50308

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									Low Emission Zone Vehicle Registration Form
Use this form if your vehicle is affected by the Low Emission Zone (LEZ) and Transport for
London (TfL) does not have all the relevant details of your vehicle on their database. TfL
hold records for most GB registered vehicles. You can check the information held by TfL
using the compliance check at tfl.gov.uk/lezlondon or by calling 0845 607 0009.
Areas in bold are compulsory fields and must be completed. Sections 1, 2 and 4 are
compulsory. A photocopy of the vehicle registration document must be supplied
with the form otherwise your application will be rejected.
Please complete in BLACK ink.
Please read the guidance notes before completing this form so that you provide
the right information for the vehicle.

Section 1 - About You

Title (Mr, Mrs, Miss, Ms)
First Name
Middle Initial(s)
Last Name
Organisation Name
Address




Post Code/Zip
Country
Daytime Telephone No
Evening Telephone No
Mobile Telephone No
Email Address


How would you prefer us to contact you?                    By Email           By Post
Tick ✓
         Please tick this box if you are happy for us to contact you to take part in a customer
         satisfaction survey.

                                                                                 LEZ_REG v1.0
Section 2 - About The Vehicle
Please tick ONE of the following boxes to indicate the type of vehicle being
registered and fill in the relevant information.
        Heavier Lorries                                                     Gross Weight                             (tonnes)
        Goods vehicles exceeding 12 tonnes
        (gross vehicle weight)

        Lighter Lorries                                                     Gross Weight                             (tonnes)
        Goods vehicles between 3.5 and 12 tonnes
        (gross vehicle weight)

        Buses and Coaches                                                   Gross Weight                             (tonnes)
        Passenger Vehicles with more than 8 seats plus
        the drivers seat exceeding 5 tonnes                                 Number of seats
        (gross vehicle weight)                                              (incl. driver)

        Large Vans                                                          Gross Weight                             (tonnes)
        Goods vehicles between 1.205 tonnes (unladen)
        and 3.5 tonnes
        (gross vehicle weight)                                              Unladen Weight                           (tonnes)

        Minibuses                                                           Gross Weight                             (tonnes)
        Passenger Vehicles with more than 8 seats plus
        the drivers seat below 5 tonnes                                     Number of seats
        (gross vehicle weight)                                              (incl. driver)

N.B. The vehicle weight is a good guide as to when your vehicle will be affected by the LEZ. If your type of vehicle does not
appear here you should use the weight limits used for lorries and large vans set out in the guidance notes as a guide and/or
contact your vehicle manufacturer or Transport for London (TfL) for guidance.

Please complete the following details which can be found on the vehicle registration
document (V5C)
Country Issuing The
Registration Certificate
Vehicle Registration Mark
(Number Plate)
Date of First Registration d d                     mm        y y y y

Vehicle Identification Number
(VIN)/Chassis Number/
Frame Number
Make
Model
Year of Manufacture                     y y y y

Fuel Type (Please tick only one of the following)

        Diesel (heavy oil, bio diesel)                              Gas Diesel (dual fuel)
        Electric Diesel (hybrid)                                    Gas (spark ignition)
        Other (please specify)
Original Euro standard as shown on your vehicle registration document

      Euro I/1         Euro II/2        Euro III/3      Euro IV/4       Euro V/5

Section 3 - Next Steps
Please tick all that apply

       This is a Showman’s vehicle which is custom built and permanently fitted with
       equipment forming part of the show. I am enclosing at least four photographs as
       specified in the guidance notes. Go to Section 4
       This vehicle is not registered in Great Britain and was constructed before
       1 January 1973. Go to Section 4
       A pollution abatement device has been fitted to this vehicle. Go to Section 3.1
       The engine has been replaced or was manufactured to meet Euro III/3 emmisions
       standards or better, prior to October 2001. Go to Section 3.2
       The vehicle has been converted to run on gas. Go to section 3.3
       None of the above applies to this vehicle . Go to Section 4

Section 3.1 - Pollution Abatement Equipment
Use this section if a pollution abatement device has been fitted to the vehicle.

Pollution Abatement
Device Manufacturer
Pollution Abatement
Device Type
Please state the vehicle’s particulate levels following fitment of the pollution abatement
device. Please complete only one of the following:

1. Vehicle Euro Standard

      Euro I/1        Euro II/2        Euro III/3     Euro IV/4         Euro V/5

or 2. Particulate Matter Emissions                   g/km or                    g/kWh

or 3. Particulate Matter                             % reduction

Please confirm by ticking the box below that a photocopy of the following has been
provided. NOTE - Please do not send originals as these will not be returned.
                             Date of Issue                   Date of Expiry
    Inspection Certificate d d       mm       y y y y          d d   mm       y y y y
    Certifying Authority
Section 3.2 - Engine Details
Use this section if the vehicle:
• Was registered as new prior to 1 October 2001 but has an engine that achieves
  Euro III/3 emissions standards or better.
• Has had a new or replacement engine fitted.

Engine make (manufacturer)

Engine type (model)

Please state the engine’s particulate levels. Please complete only one of the following:

1. Engine Euro Standard

     Euro I/1          Euro II/2         Euro III/3      Euro IV/4       Euro V/5

or 2. Particulate Matter Emissions (as per Engine Type Approval Certificate or Inspection
      Certificate)

                      g/km or                    g/kWh

Please confirm by ticking the box(es) that a photocopy of one of the following has been
provided. NOTE - Please do not send originals as these will not be returned.

                                Date of Issue                  Date of Expiry
      Vehicle Type          d d mm               y y y y        d d    mm       y y y y
      Approval Certificate
      (from the vehicle manufacturer)
                                Date of Issue                  Date of Expiry
      Engine Type           d d mm               y y y y        d d    mm       y y y y
      Approval Certificate
      (from the engine manufacturer)
                                Date of Issue                  Date of Expiry
      Certificate of               d d   mm      y y y y        d d    mm       y y y y
      Fitting
      Issuing Authority

                                Date of Issue                  Date of Expiry
      Inspection                   d d   mm      y y y y        d d    mm       y y y y
      Certificate
      Certifying Authority
Section 3.3 - Fuel Conversion
Use this section if the vehicle has been converted to run on gas.

Fuel Conversion Kit
Manufacturer
Fuel Conversion Kit Type

Please state the fuel type that the engine now uses

     Gas (spark ignition)            Other (please specify)



Please confirm by ticking the box that a photocopy of one of the following has been
provided. NOTE - Please do not send originals as these will not be returned.
                             Date of Issue                  Date of Expiry
      Certificate of          d d mm y y y y                 d d mm y y y y
      Fitting
      Issuing Authority

                             Date of Issue                     Date of Expiry
      Inspection             d d     mm      y y y y           d d     mm       y y y y
      Certificate
      Certifying Authority

Checklist
Before sending this to us, please check that you have completed the following:

     Section 1

     Section 2

     Photocopied vehicle registration document supplied

     Section 4 signed and dated
If any part of section 3 has been completed, photocopies of evidence to support:

     Eligibility for a 100% discount for a Showman’s vehicle

     Photocopied proof that a pollution abatement device has been fitted

     Photocopied proof of the engine details

     Photocopied proof of a gas conversion

Please only send photocopies of documents - originals will not be returned.
Section 4 - Declaration
Please read the following declaration very carefully and sign where indicated to confirm that you
have read and understood it. If you do not sign and date this declaration then your application will
be rejected.
By signing this form, I certify that I fully understand the criteria for registering a vehicle affected by
the London Low Emission Zone (LEZ) with Transport for London (TfL) as set out in the guidance
notes. The details given on this form are to the best of my knowledge true and correct and I
understand that filing a false declaration knowingly and wilfully is a criminal offence for which I may
be prosecuted.
In accordance with the requirements of the LEZ Scheme Order I undertake to notify TfL of any
change in circumstances that may affect the validity of the vehicle to travel in the LEZ without
paying the daily charge.
By signing this form, I confirm that I am aware of the data protection information provided in the
guidance notes to this form. Where TfL requires verification from a third party (relevant third parties
are listed in the guidance notes), I request that the appropriate third party provide TfL with the
information required to verify that the information I have supplied on this form is correct. I
understand that TfL needs to identify possible fraudulent statements of emissions standards and
use of the discount. I accept that this may include on-street checks and the analysis of the
movements of randomly selected vehicles in the LEZ. I agree that if I have applied for a discount or
exemption to which the vehicle is not entitled, TfL may disclose relevant details to Law
Enforcement agencies. I understand that TfL may share data provided in the form with other Local
Authorities and the Police for the prevention and detection of crimes and the protection of public
funds.
I understand that the vehicle details included in this application will not be updated on TfL’s register
until I have received written confirmation from TfL of the outcome of this application. If the vehicle
travels within the LEZ before the vehicle registration is approved, and the daily charge is not paid, I
understand that the registered keeper may be liable to pay a Penalty Charge.
I understand and accept that Authorised Officers working on behalf of TfL may ask to inspect the
vehicle before or after issue of a compliant or discount status or exemption to confirm I have given
correct information. If this consent is not given, TfL may not issue the vehicle with a compliant or
discount status or exemption or the compliant or discount status or exemption may be withdrawn.


Signature                                                   Date      d d      mm        y y y y

Marketing Notice
Transport for London (TfL) would like to update you on its transport related products
including the Low Emission Zone and other transport related issues. Updates may reflect
the TfL products and services you have used before and may be by mail, e-mail or
telephone. TfL will not disclose your details to third parties for marketing purposes.

If you would like to receive these updates, please tick this box

								
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