Division APPROVAL CERTIFICATE FOR DIGITAL TACHOGRAPHSX1

Name of competent administration …

Notification concerning ^f1 :

1. □

   recording equipment model

2. □

   recording equipment component ^f2

3. □

   a driver's card

4. □

   a workshop card

5. □

   a company card

6. □

   a controller's card

Approval No:

….

1. 1..

   Manufacturing brand or trademark …

2. 2..

   Name of model …

3. 3..

   Name of manufacturer …

4. 4..

   Address of manufacturer …

5. 5..

   F1Submitted for approval on …

6. 6..

   Laboratory(-ies) …

7. 7..

   Date and number of test report …

8. 8..

   Date of approval …

9. 9..

   Date of withdrawal of approval …

10. 10..

    Model of recording equipment(s) with which the component is designed to be used

11. 11..

    Place …

12. 12..

    Date …

13. 13..

    Descriptive documents annexed …

14. 14..

    Remarks (including the position of seals if applicable)

(Signature)