L 302/52
EN
Official Journal of the European Union
22.11.2022
ANNEX 3A
Communication (Maximum format: A4 (210 × 297 mm)) issued by:
Name of administration: ..................................................................................
..................................................................................
..................................................................................
Concerning (2): Approval granted Approval extended Approval refused Approval withdrawn Production definitively discontinued of a type of vehicle/component/separate technical unit (2) with regard to Regulation No. 10.
Approval No.: .............................................................................
Extension No.: ............................................................................
1.
Make (trade name of manufacturer): .............................................................................................
............................................
2.
Type: .............................................................................................
.............................................................................................
.......
3.
Means of identification of type, if marked on the vehicle/component/separate technical unit (2) ...............................
3.1.
Location of that marking: .............................................................................................
...............................................................
4.
Category of vehicle: .............................................................................................
..........................................................................
5.
Name and address of manufacturer: .............................................................................................
.............................................
6.
In the case of components and separate technical units, location and method of affixing of the approval mark: ...
7.
Address(es) of assembly plant(s): .............................................................................................
....................................................
8.
Additional information (where applicable): See appendix below
9.
Technical Service responsible for carrying out the tests: .............................................................................................
......... ... .............................................................................................
...................................................................................
..........................
10.
Date of test report: .............................................................................................
........................................................................... 11.
Number of test report: .............................................................................................
.................................................................... 12.
Remarks (if any): See appendix below (1) Distinguishing number of the country which has granted/extended/refused or withdrawn approval (see Regulation, provisions on approval).
(2) Strike out what does not apply.