190x Filetype DOCX File size 0.09 MB Source: www.nhvr.gov.au
Vehicle Approval Application Form Heavy Vehicle National Law S23 Heavy Vehicle (General) National Regulation S13 CHECK LIST FOR SUBMITTING A PBS VEHICLE APPROVAL APPLICATION 1 If vehicles are being added to an existing Vehicle Approval: - please highlight the new vehicles in bold; and - if known please provide previous Vehicle Approval reference number (previously Final Approval) - if interchangeability of units is required please list ALL VIN’s in the supporting certificate. If all units are not interchangeable provide a table showing the VIN’s that are interchangeable 2 Identify Design Approval Vehicle Combination / Dimension Set, eg “Vehicle 4c” 3 Please provide a drawing, a Design Approval drawing for Tier 1 or an “As Built” drawing for Tier 3, due to jurisdictional access permit requirements. Please ensure that the drawing is legible and shows the full prospective of the combination(s). Other drawings may be requested by the NHVR. 4 Please provide certificate in both MS Word and PDF formats 5 Please provide ALL drawings in JPEG or PDF format. 6 Please make sure that all vehicles you want to appear on VA are covered in this certification 7 If during inspection anomalies have been identified please provide a sign-off from the applicable Assessor: - if significant anomalies occur please supply an updated Part B from the Assessor CERTIFIER DECLARATION I hereby certify that the information in this Vehicle Approval application and the attached Certifier’s Certificate any supporting documents are true and correct. Giving false and misleading information is a serious offence (Section 702 of the Heavy Vehicle National Law). Penalties apply. Name of certifier: Address: Date: __ __ / __ __ / __ __ __ __ Signature: The NHVR is collecting your personal information to issue a PBS Vehicle Approval under Chapter 1 of the Heavy Vehicle National Law and Section 13 of the Heavy Vehicle (General) National Regulation. We are authorised under this Act to collect information we reasonably require to decide this application. We may disclose protected information contained in your application for the purposes set out in section 727 of the Act to an entity (including a private or public sector entity) identified in that section. This can include disclosure to an authorised employee or agent of the entity. We may disclose protected information to a law enforcement agency, including a service provider authorised to enforce the Heavy Vehicle National Law nationally. A police agency may disclose protected information disclosed to or otherwise held by it to another police agency authorised to hold protected information. Page 1 of 4 NHVR0050-202105 National Heavy Vehicle Regulator www.nhvr.gov.au Certifier’s Certificate Heavy Vehicle (General) National Regulator S13: DESIGN APPROVAL CERTIFIER’S CERTIFICATE Application Number Variation Design approval Certificate Issue Number number Dimension Set 1 Dimension Set 2 CERTIFIER’S COMMENTS (ANOMALIES) 1 2 3 Page 2 of 4 NHVR0050-202105 National Heavy Vehicle Regulator www.nhvr.gov.au Details of Trucks(s) or Prime Mover(s) Inspected Make Model VIN(s) Engine Make Model Transmission Make Model Differential Make Model FD Ratio Suspension Make Model (Steer) Suspension Make Model (Drive) Tyres Size Make Model (Steer) Tyres Size Make Model (Drive) Brakes (Load Proportioning, ABS, ECB, etc) Tow Coupling Type D Rating Wheelbase (mm) Vehicle Height (From the ground) (mm) Number of Axles ADR category GVM (kg) GCM (kg) Comments / Notes: Page 3 of 4 NHVR0050-202105 National Heavy Vehicle Regulator www.nhvr.gov.au Details of Dolly(s) Trailer(s) Inspected Type Make Model VIN(s) Suspension Make Model Tyres Size Make Model Drawbar Length (mm) Coupling Type D Rating Brakes (Load Proportioning, ABS, ECB, etc) Wheelbase (mm) Vehicle Height (From the ground) (mm) Number of Axles ADR category ATM (kg) Comments / Notes: INSPECTION DETAILS Certifier’s name Accreditation No Inspection location Inspection date CERTIFIER’S CERTIFICATION I certify that I have inspected this vehicle in accordance with the Vehicle Certification Rules and that the vehicle has all the required physical characteristics as set out in the Vehicle Certification Information document supplied to me by the Performance Based Standards Review Panel in relation to the vehicle. Signature _____________________________________ Date ____ /____ /______ Page 4 of 4 NHVR0050-202105 National Heavy Vehicle Regulator www.nhvr.gov.au
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