ANNEX VI

MODEL A Maximum format: A4 (210 × 297 mm)

SECTION I

0.1. Make (trade name of manufacturer):

0.2.

Type:

0.2.1. Commercial name(s)(1):

0.3.

Means of identification of type, if marked on the vehicle:

0.3.1. Location of that marking:

0.4. Category of vehicle(2):

0.5. Name and address of manufacturer of the complete vehicle^a:

Name and address of manufacturer of the base vehicle^a (3):

Name and address of manufacturer of the latest built stage of the incomplete vehicle^a (3):

Name and address of manufacturer of the completed vehicle^a (3):

0.8. Name(s) and address(es) of assembly plant(s):

0.9. Name and address of the manufacturer’s representative (if any):

(1)

If not available at the time of granting the type-approval, this item shall be completed at the latest when the vehicle is introduced on the market.

(2)

As defined in Annex II.A.

(3)

See side 2.