# Commission Implementing Regulation (EU) 2017/548 of 23 March 2017 laying down a standard form for the written statement on the removal or breakage of a tachograph seal (Text with EEA relevance), Annex: Written statement on the removal or breakage of a tachograph seal

Extent: E+W+S+N.I.

1.. Vehicle registration number
2.. Vehicle identification number
3.. Driver name
4.. Community licence of the haulier or the carrier
5.. Workshop name
6.. Workshop address
7.. Workshop identification number
8.. Name of the member of staff responsible for the removal of the seal
9.. Number of removed seal
10.. Date and time of seal removal
11.. Reason(s) for removal
12.. Remarks
Place and date
Signature of the member of staff
Signature of the driver

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Source: https://www.legislation.gov.uk/eur/2017/548/annex (the official version)
Page: https://openlegislation.uk/eu-regulation-2017-548/annex
Contains public sector information licensed under the Open Government Licence v3.0. Source: legislation.gov.uk, The National Archives.