22.11.2022
EN
Official Journal of the European Union
L 302/55
ANNEX 3B
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Concerning (2): Approval granted Approval extended Approval refused Approval withdrawn Production definitively discontinued of a type of electrical/electronic sub-assembly (2) with regard to Regulation No. 10.
Approval No.: .............................................................................
Extension No.: ............................................................................
1.
Make (trade name of manufacturer): .............................................................................................
........................................
2.
Type and general commercial description(s): .............................................................................................
..........................
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: .............................................................................................
......................................................................
(1) Distinguishing number of the country which issued/extended/refused or withdrawn approval. (see Regulation, provisions on approval).
(2) Strike out what does not apply.