Division Information on the type-approval procedure chosen in accordance with Article 25(1) of Regulation (EU) No 168/2013

A duly completed version of this statement shall be included in the information folder.

The undersigned: [… (full name and position)]

Company name and address of the manufacturer: …

Name and address of the manufacturer’s representative (if any): …

Hereby applies for type-approval procedure⁽⁴⁾:

1. (a)

   step-by-step type-approval

2. (b)

   single-step type-approval

3. (c)

   mixed type-approval

Where procedures (a) or (c) are chosen, compliance with requirements as under (b) is declared for all systems, components and separate technical units.

Multi-stage type-approval chosen in accordance with Article 25(5) of Regulation (EU) No 168/2013: yes/no⁽⁴⁾

Information on the vehicle(s) to be filled in, if application is for EU whole-vehicle type-approval⁽³⁾ :

1. 0.1.

   Make (trade name of the manufacturer): …

2. 0.2.

   Type⁽¹⁷⁾: …

   1. 0.2.1.

      Variant(s)⁽¹⁷⁾: …

   2. 0.2.2.

      Version(s)⁽¹⁷⁾: …

   3. 0.2.3.

      Commercial name(s) (if available): …

3. 0.3.

   Category, subcategory and sub-subcategory of vehicle⁽²⁾: …

Information to be filled in, if application is for type-approval of a system/ component/separate technical unit⁽³⁾⁽⁴⁾ :

1. 0.7.

   Make(s) (trade name(s) of manufacturer): …

2. 0.8.

   Type: …

   1. 0.8.1.

      Commercial name(s) (if available): …

3. 1.6.

   Virtual and/or self-testing⁽³⁾

   1. 1.6.1.

      Overview list with virtual and/or self-tested systems, components or separate technical units pursuant to point 6 of Annex III to Commission Delegated Regulation (EU) No 44/2014 below:

      Overview table virtual and/or self-testing
      Commission Delegated Regulation (EU) No 134/2014 of 16 December 2013 supplementing Regulation (EU) No 168/2013 of the European Parliament and of the Council with regard to environmental and propulsion unit performance requirements and amending Annex V thereof (OJ L 53, 21.2.2014, p. 1).
      Delegated act	Annex	Subject	Virtual and/or self-tested: yes/no(4)
      Commission Delegated Regulation (EU) No 134/2014f1	IX	Testing procedures on maximum design vehicle speed	Self-testing: yes/no(4)
      Commission Delegated Regulation (EU) No 3/2014	II	Audible warning devices	Self-testing: yes/no(4)
      Commission Delegated Regulation (EU) No 3/2014	VIII	Driver-operated controls including identification of controls, tell-tales and indicators	Self-testing: yes/no(4)
      Commission Delegated Regulation (EU) No 3/2014	IX	Installation of lighting and light- signalling devices	Virtual testing: yes/no(4)
      Commission Delegated Regulation (EU) No 3/2014	X	Rearward visibility	Virtual testing: yes/no(4)
      Commission Delegated Regulation (EU) No 3/2014	XIV	Installation of tyres	Virtual testing: yes/no(4)
      Commission Delegated Regulation (EU) No 44/2014	XIV	Registration plate space	Self & Virtual testing: yes/no(4)
      Commission Delegated Regulation (EU) No 44/2014	XVI	Stands	Self-testing: yes/no(4)
      This Commission Implementing Regulation	VIII	Statutory plate and EU type-approval mark	Self-testing: yes/no(4)

   2. 1.6.2.

      Detailed report on validation of virtual and/or self-testing added: yes/no⁽⁴⁾