Appendix 22

United Kingdom

Model information document relating to EU type-approval of a safety belt as a component/STU

GENERAL INFORMATION

GENERAL INFORMATION CONCERNING SYSTEMS, COMPONENTS OR SEPARATE TECHNICAL UNITS

2.1.

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

F12.2.

Type ( ⁶ ) : …

2.2.1.

Commercial name(s) (if available): …

2.2.2.

Type-approval number(s) (⁴⁹) (if available): …

2.2.3.

Type-approval(s) issued on (date, if available): …

F22.2.4.

For components and separate technical units, location and method of attachment of the type-approval mark(s) (if available) ( ¹⁹ ): …

2.3.

Company name and address of manufacturer: …

2.3.1.

Name(s) and address(es) of assembly/manufacture plants: …

2.3.2.

Name and address of manufacturer's authorised representative (if any): …

2.4.

For systems and separate technical units, vehicle(s) for which they are intended for (²¹):

2.4.1.

Type (¹⁷): …

2.4.2.

Variant(s) (¹⁷): …

2.4.3.

Version(s) (¹⁷): …

2.4.4.

Commercial name(s) (if available): …

2.4.5.

Category, subcategory and speed index of the vehicle (²): …

54.

SAFETY BELTS

54.1.

Requirements under standard ISO 3776-3:2009 (Tractors and machinery for agriculture — Seat belts — Part 3: Requirements for assemblies) are met with relevant documentation included in the information document: yes/no (⁴)

54.2.

Test report granted a on the basis of UNECE Regulation No 16 (OJ L 233, 9.9.2011, p. 1) with relevant documentation included in the information document: yes/no (⁴)

F354.3.

Number and position of safety belts and seats on which they can be used, please fill out table below:

Safety belt configuration and associated information

			Complete EU type-approval mark / ECE type-approval mark	Variant, if applicable	Belt adjustment device for height (indicate yes/no/optional)
L = left, C = centre, R = right
Driver's seat		L
		C
		R
Passenger seat 1		L
		C
		R
Passenger seat …		L
		C
		R

54.4.

Brief description of electrical/electronic components: …

Annotations

Textual amendments

F1: Substituted by Commission Implementing Regulation (EU) 2018/986 of 3 April 2018 amending Implementing Regulation (EU) 2015/504 as regards the adaptation of the administrative provisions for the approval and market surveillance of agricultural and forestry vehicles to Stage V emission limits (Text with EEA relevance).
F2: Inserted by Commission Implementing Regulation (EU) 2016/1789 of 7 September 2016 amending Implementing Regulation (EU) 2015/504 with regard to the administrative requirements for the approval and market surveillance of agricultural and forestry vehicles (Text with EEA relevance).
F3: Substituted by Commission Implementing Regulation (EU) 2016/1789 of 7 September 2016 amending Implementing Regulation (EU) 2015/504 with regard to the administrative requirements for the approval and market surveillance of agricultural and forestry vehicles (Text with EEA relevance).