I Request Permission to Incorporate Into the Road Vehicle Load Compartments Manufactured

GV204

Rev.Sept 2018

I request permission to incorporate into the road vehicle load compartments manufactured to the specification and conditions of the above authorised design-type the variation/group of variations listed below.

I believe that the proposed changes would not alter the basic design to such an extent as to constitute a new design. Two sets of the relevant drawings are enclosed.

A remittance of £ is enclosed (see currentfees on or debit customer account number ______or telephone______for debit/credit card payment.(Cheques should be crossed and made payable to ‘DVSA’’)

Signature

Full Name (BLOCK CAPITALS)

Position (manager, secretary, etc)

On behalf of (manufacturer)

Business Address

Telephone No: Date

For Office Use only overleaf

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For Official Use Only

1. Details of the proposed variations and drawings listed overleaf have been examined and the variation certificate procedure* “is/is not” appropriate in this case.

The applicant was notified accordingly on and arrangements have been made to examine a load compartment in which the variation have been incorporated at the manufacturers works on .

1. A load compartment in this design-type series *bearing/allocated the Serial Number

______and incorporating the *variation/group of variations listed overleaf was inspected by on and found to be;

*UNSATISFACTORY and a copy of Notification of Refusal (GV66) is attached

*SATISFACTORY and a variation certificate can be issued

1. The items of non-compliance listed on the Notification of Refusal have been rectified and the application overleaf refers to the (1st, 2nd, 3rd etc) variation of group of variations to be incorporated in load compartments produced under this design-type authorisation andVARIATION CERTIFICATE NUMBER (1, 2, 3 etc.) has been issued.
2. Thesevariations *do / do not alter the external appearance of the load compartments andphotographs *are attached/are not required.
3. One and set of the relevant drawings have been authenticated and returned to the manufacturer with the certificate.
4. Variation certification procedure is not required, refund is approved.

Issuing Officers Signature DVSA Stamp

Issuing Officers Name (BLOCK CAPITALS)

____

Date

*Delete where necessary

1

DVSA 646 GV204 Revised Sept 2018