1. |
Trade name or mark of the vehicle................................................................................................................................................................................................ |
2. |
Vehicle
type....................................................................................................................................................................................................................................... |
3. |
Manufacturer's name and
address................................................................................................................................................................................................. |
4. |
If applicable, name and address of manufacturer's
representative........................................................................................................................................... |
5. |
Brief description of the vehicle type as regards the
arrangement of foot
controls................................................................................................................ |
6. |
Vehicle submitted for approval
on................................................................................................................................................................................................. |
7. |
Technical service responsible for conducting approval
tests................................................................................................................................................... |
8. |
Date of test report issued by that
service..................................................................................................................................................................................... |
9. |
Number of test report issued by that
service............................................................................................................................................................................... |
10. |
Approval granted/extended/refused/withdrawn 2/
.................................................................................................................................................................... |
11. |
Position of approval mark on the
vehicle...................................................................................................................................................................................... |
12. |
Place.................................................................................................................................................................................................................................................... |
13. |
Date..................................................................................................................................................................................................................................................... |
14. |
Signature............................................................................................................................................................................................................................................ |
|
The list of documents deposited with the Administrative
Service which has granted approval is annexed to this communication and may
be obtained on request. |