ANNEX IStandard models for the information document and the EC type-approval certificate

PART 2

MODEL

(maximum format: A4 (210 × 297 mm))

EC TYPE-APPROVAL CERTIFICATE

Stamp of type-approval authority

Communication concerning:

  • EC type-approval16

  • Extension of EC type-approval16

  • Refusal of EC type-approval16

  • Withdrawal of EC type-approval16

of a type of vehicle with regard to lane departure warning systems

with regard to Commission Regulation (EU) No 351/2012 as amended.

EC type-approval Number: _

Reason for extension:

SECTION I

0.1.

Make (trade name of manufacturer):

0.2.

Type:

0.2.1.

Commercial name(s) (if available):

0.3.

Means of identification of type if marked on the vehicle17:

0.3.1.

Location of that marking:

0.4.

Category of vehicle18:

0.5.

Name and address of manufacturer:

0.8.

Names and address(es) of assembly plant(s):

0.9.

Representative of the manufacturer:

SECTION II

1.

Additional information (where applicable): see Addendum

2.

Technical service responsible for carrying out the tests:

3.

Date of test report:

4.

Number of test report:

5.

Remarks (if any): see Addendum

6.

Place:

7.

Date:

8.

Signature:

Attachments

Information package.

Test report.