Docstoc

Application for a Certificate of Initial Fitness

Document Sample
Application for a Certificate of Initial Fitness Powered By Docstoc
					 Public Passenger Vehicles Act 1981


 Application for a Certificate of
 Initial Fitness
                                                                                              Please write in CAPITALS and black ink.
 1. APPLICANT DETAILS

 Title :           Forename :                            Surname :

 Company Name :
 (if applicable)

 Address :




 Town / City :

 Post Code :                                              Daytime Tel. Number :

 Email Address :

 2. TEST STATION DETAILS
 Test Station Name (or name of other authorised premises)
 where you wish the vehicle to be examined :
 Note : Examinations are normally conducted at VOSA Test Stations. It may, however, be possible to conduct the examination at
 another location but only with the agreement of the Certifying Officer. If you have not been contacted, please allow 3 clear weeks for
 your application to be processed prior to contacting the Certifying Officer.

 3. FEE DETAILS
 Please ensure that you have enclosed the correct fee (for current fees please call the VOSA National Number - 0300 123 9000).
 Cheques or postal orders should be crossed and made payable to “VOSA”. Please do not send notes or cash by post. You will be
 contacted by telephone for debit / credit card payments.
                   Postal        Credit or                           Cash                               Pre-funded
  Cheque
                   Order        Debit Card        (ONLY when application is presented in person)          Account

 4. VEHICLE DETAILS
 Reg                                         Full Chassis
 Mark :                                      (VIN) No. :

  Has the vehicle been TYPE APPROVED to the requirements of Directive 2001/85/EC?
                                                                                                             YES            NO
   (If so, please enclose a copy of the Type Approval Certificate)
    Has the vehicle been BUILT (but not approved) to the requirements of Directive 2001/85/EC?              YES            NO
    Has the vehicle been TYPE APPROVED to ECE Regulation No. 107.2?
                                                                                                             YES            NO
     (If so, please enclose a copy of the Type Approval Certificate)
    Has the vehicle been BUILT (but not approved) to ECE Regulation No. 107.2?                              YES            NO

    If the vehicle has not been approved or built to Directive 2001/85/EC or ECE Regulation No. 107.2, is the vehicle
     requiring an Accessibility Certificate to :

     Schedule One – Wheelchair Accessibility (Buses and Coaches)?                                            YES            NO

     Schedule Two – General Accessibility (Buses)?                                                           YES            NO

     Schedule Three – General Accessibility (Coaches)?                                                       YES            NO

    Does the vehicle require a Reduced Pollution Certificate?                                               YES            NO

                                   Make                                 Model                      Month / Year of Manufacture
    Chassis :

    Body :



PSV 417 (VOSA 106)                                             1                                           Version 1.0 October 2010
 4. VEHICLE DETAILS CONTINUED…

    Vehicle Completion Date (month / year) :

    Engine Make :                                                                    Fuel :

    Engine Model :                                                             Power (kW) :

    Number of Passengers
                                            Upper Deck :                                            Lower Deck :
     (Maximum)

                                              Standees :                                            Wheelchairs :

    External Dimensions (mm)                    Height :                                                Length :

    Design Weights Shown on
                                                  Axle 1 :                                                Axle 2 :
     Manufacturer’s Plate (kg)

                                                  Axle 3 :                                                 GVW :

    Type of Suspension
                                Axle 1 :                             Axle 2 :                                Axle 3 :
     (e.g. Air, Leaf etc.)
    Seat Belts (in addition to any mandatory belts) :
     Have the additional belts all been subject to a statutory installation check?                 YES                     NO
     Is the vehicle exempt by virtue of the manufacturer having provided evidence
                                                                                                   YES                     NO
     to VOSA that the installation has been fully type approved?
    Special Features :
     Air Conditioning                           Crew Seats                                     Television / Video
     Alloy Wheels                               Double Glazing                                 Toilet
     Combustion Heater                          Luggage Pen                                    Wheelchair Lift or Ramp
     Crew Compartment                           Retarder
 Note : The Agency may require evidence that certain installations and/or systems have been type approved or tested to the
 requirements of the Regulations. This relates to those items which require specialist test facilities and applies to new chassis, body
 or engine models for which the Agency has no previous record of compliance.

 5. APPROVAL DETAILS
 This application is required to be supported by evidence of EC Directive compliance for the following items: Brakes to Directive
 71/320/EEC as amended; Engine Emissions to Directive 70/220/EEC as amended, or 88/77/EEC as amended, and Sound Levels to
 Directive 70/157/EEC as amended or in either case any equivalent ECE Regulation. This information must be obtained from the
 vehicle manufacturer.

 6. 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.

 7. DECLARATION
 I declare that, to the best of my knowledge, all statements in this application are true.

 Signed :                                              Name :                                                  Date :

 Please send this form to : PSV Section, VOSA, Ellipse, Padley Road, Swansea, SA1 8AN
 Official Use Only:




PSV 417 (VOSA 106)                                               2                                                  Version 1.0 October 2010

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:22
posted:6/30/2011
language:English
pages:2