Appendix 1
United Kingdom
Model of the EU type-approval authorisation certificate for the placing on the market and entry into service of parts or equipment which may pose a serious risk to the correct functioning of essential systems
EU AUTHORISATION CERTIFICATE
MODEL
Format: A4 (210 × 297 mm)
EU AUTHORISATION CERTIFICATE
Stamp of approval authority
Communication concerning the
| for the placing on the market and entry into service of parts or equipment which may pose a serious risk to the correct functioning of systems that are essential for the safety of the vehicle or for its environmental performance |
SECTION I
Kind of part/equipment (1) …
Part/equipment (1) numbers: …
EU authorisation certificate number: …
Reason for extension/refusal/withdrawal (1): …
Name and address of manufacturer: …
Name(s) and address(es) of assembly plant(s): …
Name and address of the manufacturer's representative (if any): …
SECTION II
The part/equipment (1) is specifically intended for installation on the following vehicle(s):
Make (trade name of manufacturer): …
Type(s) (2): …
Variant(s) (2) …
Version(s) (2): …
SECTION III
Prescriptions for:
- (a)
vehicle construction safety (1): …
- (b)
vehicle functional safety (1): …
- (c)
vehicle braking performance (1): …
- (d)
vehicle environmental protection (1): …
- (e)
testing standards (1): …
SECTION IV
Prescriptions based on:
- (a)
Annex(es) … (3) to Commission Delegated Regulation (EU) (No) (1) …/… (and Annex(es) … (3) to Commission Delegated Regulation (EU) (No) (1) …/…) (1), as last amended by (Commission Delegated) (1) Regulation (EU) (No) (1) …/… (1) (4) (of the European Parliament and of the Council) (1)
- (b)
a comparison of the part/equipment (1) with the safety/environmental (1) performance of the original vehicle/parts of the original vehicle (1) (explain) (1): …
…
SECTION V — TECHNICAL SERVICE
Technical service responsible for carrying out the tests: …
Date of test report: …
Number of test report: …
SECTION VI
The part/equipment (1) does not/does (1) impair the functioning of those systems that are essential for the safety of the vehicle or its environmental performance.
The authorisation certificate is granted/extended/refused/withdrawn (1)
Place: …
Date: …
Name and signature (or visual representation of an ‘advanced electronic signature’ according to Directive 1999/93/EC of the European Parliament and of the Council, including data for verification): …
…
Attachments:
Test report
Explanatory notes relating to Appendix 1
(Footnote markers, footnotes and explanatory notes not to be stated on the EU type-approval authorisation certificate):
(1)
Delete where not applicable.
(2)
Indicate the alphanumeric code Type-Variant-Version or ‘TVV’ allocated to each type, variant and version as set out in point 2.3 of Part B of Annex I to this Regulation. For the identification of variant and versions it may be employed the matrix set out in point 2.2 of Part B of Annex I to this Regulation.
(3)
The Roman numeral of the relevant Annex to the Commission Delegated Regulation or multiple Roman numerals of the relevant Annexes to the same Commission Delegated Regulation.
(4)
Indicate the latest amendment of the Commission Delegated Regulation according to the amendment applied for the EU type-approval.