F1ANNEX IIIBMODEL

(maximum format: A4 (210 × 297 mm))

Annotations:

F1EC TYPE-APPROVAL CERTIFICATE

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Communication concerning the:

  • type-approval20

  • extension of type-approval20

  • refusal of type-approval20

  • withdrawal of type-approval20

of a type of vehicle/component/separate technical unit20 with regard to F1Directive 75/322/EEC, as last amended by Directive …/…/EC.

Type-approval number:

Reason for extension:

SECTION I

0.1.

Make (trade name of manufacturer):

0.2.

Type and general commercial description(s):

0.3.

Means of identification of type, if marked on the vehicle/component/separate technical unit2021:

0.3.1.

Location of that marking:

0.4.

F1Vehicle:

0.5.

Name and address of manufacturer:

0.7.

In the case of components and separate technical units, location and method of affixing of the EEC approval-mark:

0.8.

Address(es) of assembly plant(s):

SECTION II

1.

Additional information (where applicable): See Appendix

2.

Technical service responsible for carrying out the tests:

3.

Date of test report:

4.

Number of test report:

5.

Remarks (if any): See Appendix

6.

Place:

7.

Date:

8.

Signature:

9.

The index to the information package lodged with the approval authority, which may be obtained on request is attached.