Division Information folder sheet

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 (⁴): …

Name and address of the manufacturer's representative (if any) (⁴): …

Hereby applies for type-approval procedure:

1. (a)

   step-by-step type-approval (¹)

2. (b)

   single-step type-approval (¹)

3. (c)

   mixed type-approval (¹)

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 20(5) of Regulation (EU) No 167/2013: yes/no (¹)

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

Applies for type-approval of:

1. (a)

   a complete vehicle type (¹)

2. (b)

   completed vehicle type (¹)

3. (c)

   an incomplete vehicle type (¹)

4. (d)

   a vehicle type with complete and incomplete variants (¹)

5. (e)

   a vehicle type with completed and incomplete variants (¹)

Information to be filled in, if application is for type-approval of a system/component/separate technical unit (¹):

Place: …

Date: …

Signature: …

Name and position in the company: …