Please read the notes below BEFORE completing the form GV65 Rev. Sept 2018

I, the undersigned, apply for the Design-Type of road vehicle load compartment particulars of whichare specified below to be authorised for the International transport of goods under cover of TIR Carnets.

  1. Particulars of the vehicle

(a) Type: *Motor vehicle / *Trailer / *Semi-Trailer

(b) Body type: (e.g. van, tank, tilt)

(c) Specification reference:

(d) Drawing numbers:

______

_____

______

(e) General description:

_

(f)Applicant’s design-type identification:

2.(a) Has an application previously been made for Authorisation by

Design-Type of vehicles of the foregoing type and specification? *YES / NO

(b) If YES, please state:-

Test Station to which application was made:

Approximate date application was made:

Result of application *GRANTED / *REFUSED

Number of authorisation granted: GB/V /20

3.Address at which completed vehicle in the series can be inspected

if different from the address stated in the Declaration overleaf

4.Estimated date of completion of first vehicle: *Delete as appropriate

NOTES

  1. Applications should be made as early as possible and in any case not less than one month before authorisation is required.
  1. On completion, please attach your fully completed application to the Technical Application System (TAS) available on www.gov.uk/dvsa , alternatively, you may wish to post the application to DVSA, The Ellipse, Padley Road, Swansea, SA1 8AR.

3. A copy of the specification together with two sets of the relevant drawings must also accompany the application. Essential parts of the structure, including details of materials to be used, methods of construction, whether the assembly will be riveted, bolted, welded etc. must be stated.

4. Should you wish to have your vehicle inspected at a non-DVSA approved site you must complete an IVA9, available on www.gov.uk/dvsa, and submit it along with your application. You must also ensure the site complies with current DVSA TIR inspection facility requirements. Undercover facilities for the full examination of the vehicle including the roof and underside should be readily available. Ladders and steps are not considered an acceptable method for roof inspections. A currentsite-specific risk assessment must be available to view. The DVSA reserves the right to refuse to inspect at any premises it deems to be unsuitable.

5. 5.TIR inspection requires all parts of the load area to be assessed; to facilitate this vehicle presenters can produce photographic evidence, at the time of test, of the roof and its structural fittings for each vehicle submitted for examination.

Where an inspector is happy that there is sufficient evidence in the images to satisfy the roof area is not compromised and meets the necessary criteria there will be no need to conduct a visual examination of this part of the vehicle.

The conditions are such that images;

• must clearly identify the vehicle being presented,

• must clearly show the roof structure of the vehicle to be inspected,

• show the attachment points of the vertical structural members joining the roof structure to the sides,

• show detailed images of all mandated jointing devices and bonding methods,

• be presented at the time of inspection in a high-quality format,

• may be digital images (or video) or printed photographs.

DVSA reserve the right to conduct a visual inspection of the complete load area if there is any doubt as to the integrity of the vehicle roof or evidence supplied. In such cases, if appropriate inspection facilities are not available at the presenters chosen premises the vehicle will be failed and will only be re-examined at an alternative suitable location.

There are a small number of vehicle types which due to the technical nature of their construction photographic evidence may not be able to shown the detail required and a full visual inspection will be required (i.e. curtain sided). Presenters of these vehicles should chose a location with full inspection facilities for the examination.

Declaration

I, the undersigned, agree to:

  1. produce to the approving authority such vehicles of the type concerned as that authority may wish to examine;
  2. permit the approving authority to examine further units at any time during the production of the type series concerned;
  3. advise the approving authority of any change, however small, in the design or specification before proceeding with such change;
  4. mark the load compartments in a clearly visible place with the identification numbers and/or letters of the design-type and the serial number of the unit in the type series;
  5. provide photographs (minimum size of photographs 75mm x 50mm) as directed by the approving authority and
  6. keep a record of vehicles manufactured to the authority design-type.

I understand that failure to comply with these undertakings may result in the withdrawal of an authorisation granted in respect of this application and the invalidation of any or all certificates of approval issued in respect of road vehicles manufactured under such an authorisation.

I declare that to the best of my knowledge and belief the statements made herein are true and correct.

The appropriate remittance of £is enclosed or debit customer account number ______or telephone______for debit/credit card payment.

Signature (of authorised person)

Full Name (BLOCK CAPITALS)

Position (e.g. Manager, Secretary)

On behalf of (full name and business address)

Telephone numberDate

DATA PROTECTION STATEMENT 2018

We collect your data directly and share routinely outside of DVSA

We collect, use and store your personal data so that we can proceed with your TIR application and inspection.

We share your personal data with HM Revenue and Customsso theycan verify the authenticity of documentation and request replacements if required.

We may share your personal data if we have a lawful reason. For example as part of a criminal investigation or to prevent fraud. Find out more at www.gov.uk/dvsa/privacy.

For Official Use Only

Authorisation Number GB/V DT20

Issued ______

Issuing Officers Signature

Stamp

Issuing Officers Name (BLOCK CAPITALS)

Date

1

DVSA 639 GV65 Revised Sept 2018