APPLICATION FOR A
CERTIFICATE OF INITIAL FITNESS
PSV 417
Public Passenger Vehicles Act 1981
FAILURE TO COMPLETE THE FORM ACCURATELY OR IN FULL COULD RESULT IN
DELAYS OR REJECTION
1. APPLICANT DETAILS
Title : / Name :
Company Name (if applicable):
Address :
Town / City :
Post Code : / Tel.No. :
Email :
2. TEST STATION DETAILS
Which test location would you prefer? :
Please Note : Examinations are normally conducted at DVSA test locations. Please allow 3 clearweeks for your application to be processed. If you do not hear from us within this time, please contact our Customer Contact Centre on 0300 123 9000.
3. VEHICLE DETAILS
Reg
Mark : / Full Chassis
(VIN) No. :
  1. Is the vehicle :

  1. Type Approved to the requirements of Directive2001/85/EC?
(If so, please provide a copy of the Type Approval Certificate) / YES / NO
  1. Built (but not approved) to the requirements ofDirective 2001/85/EC?
/ YES / NO
  1. Type Approved to ECE Regulation No. 107.2?
(If so, please provide a copy of the Type Approval Certificate) / YES / NO
  1. Built (but not approved) to ECE Regulation No. 107.2?
/ YES / NO
Please Note : If an accessibility certificate (DDA) is required, please complete and attach a separate application form - PSVA 1.
Make / Model / Month / Year
of Manufacture
Chassis / /
Body / /

PSV 417

3. VEHICLE DETAILS cont…
  1. Vehicle Completion Date (month / year) :
/ /
  1. Engine Make :
/ Fuel Type :
  1. Engine Model :
/ Power (kW) :
  1. Number of Passengers (Maximum) ▼

Upper Deck / Lower Deck / Standees / Wheelchairs
  1. External Dimensions (mm)
/ Height : / Length :
  1. Original Manufacturer’s Design Weights (kg) ▼

Axle 1 / Axle 2 / Axle 3 / GVW
  1. Post Conversion Design Weights (if different from above) (kg)▼

Axle 1 / Axle 2 / Axle 3 / GVW
  1. Type of suspension (e.g. Air, Leaf etc.) ▼

Axle 1 : / Axle 2 : / Axle 3 :
j. Braking System Description :
  1. What is the ‘split’ arrangement of the service brakes system?

  1. Is the manufacturer’s designated secondary brake part of the service
brake system? / YES / NO
k. Is the vehicle fitted with seat belts? : / YES / NO
l. Special Features ▼
Air Conditioning / YES / NO / If YES, pleasegive the locationin the box below ▼
Alloy Wheels / YES / NO / Crew Seats / YES / NO / If YES, how many?
Retarder / YES / NO / If YES, please give type :
Toilet / YES / NO / Entertainment Monitor / Screen / YES / NO
Double
Glazing / YES / NO / Wheelchair Lift or Ramp / YES / NO
Crew
Compartment / YES / NO
Please Note : DVSA may require evidence that certain installations and/or systems have been type approved or tested to the requirements of the Regulations. This relates to those items which require specialist test facilities and applies to new chassis, body or engine models for which DVSA has no previous record of compliance.
PSV 417
4. APPROVAL DETAILS
Please provide evidence of EC Directive compliance (to the standard appertaining to the date on which the vehicle was manufactured) for the following items : Brakes to Directive 71/320/EEC as amended; Engine Emissions to Directive 70/220/EEC as amended, or 88/77/EEC as amended and Sound Levels to Directive 70/157/EEC as amended or in either case any equivalent ECE Regulation. This information must be obtained from the vehicle manufacturer.
5. DATA PROTECTION, DECLARATION AND SIGNATURE
DATA PROTECTION – The personal information you provide on this form will be used for the purposes of DVSA’s statutory functions. It will not be disclosed to other organisations unless required or permitted by law. For further information, visit the Personal Information Charter available from .
DECLARATION – I confirm that, as far as I know, all statements in this application are true.
Signature : / Date: / / /
Print Full Name :
Please Note : All ‘Declaration’ sections above must be completed. Atyped ‘Signature’ is
acceptable if sending your form electronically.
6. PAYMENT DETAILS
You can pay the application fee by one of the following methods :
  1. Cheques/postal orders- payable to the ‘Driver and Vehicle Standards Agency’
(or ‘DVSA’). Only accepted with postal applications.
  1. Credit/debit card - If you choose to pay by this method, then once your application has been received, you will be contacted by email with instructions on how to arrange your card payment.
  1. Pre-funded account - If you are a regular user of the scheme this is the quickest method to use. For pre-funded accounts, the signatory on the application must be a delegate authorised to use the account. For more information on setting up a pre-funded account, go to
Refund Policy – Should you wish to withdraw the request for a Certificate of Initial Fitness prior to it being issued, a full refund will be given.
Details of the current fees can be found on our website at or by telephoning ourCustomer Contact Centre on 0300 123 9000.
How are you paying for this application? (Please tick one box)
Cheque / Postal Order / Payable to ‘Driver and Vehicle Standards Agency’ or ‘DVSA’ (only with postal applications).
Credit / Debit Card / Payment to be made after application is received.
DVSA Pre-funded Account / PFA No. :
I hereby authorise the Driver and Vehicle Standards Agency to take the amount stated below
from my bank / pre-funded account in respect of my application. / £ .
Signature details : Please sign and print your name if you are either the card holder or PFA delegate. A typed ‘Signature’ is acceptable if sending your form electronically.
Signature : / Print
Name :
ON COMPLETION - Please attach your fully completed application to the ‘Technical Application System’ (TAS) available on : . Should you experience problems accessing TAS, please try an alternative browser. DVSA Customer Contact Centre : 0300 123 9000.
PSV 417(DVSA 106) / 1 / v2.2 April 2016