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Form VRTMODN1 Authorised Dealer Declaration for the reclassification of an Incomplete as a Completed Vehicle This form applies to NEW Birth-Certed Incomplete N1 vehicles only An authorised dealer before s/he applies to register a new Completed vehicle birth-certed as Incomplete e.g. Body Type 95 Chassis Cab must firstly fill out this document and ensure that they are in possession of all Type-Approval documentation for the vehicle. This completed document along with the original Type-Approval documentation of the Incomplete vehicle and the Type-Approval Document of the Completed vehicle should then be posted to FREEPOST Central Vehicle Office Revenue Commissioners Rosslare Harbour Co. Wexford or faxed to 053-9133779 to request the allocation of a new Statistical Code. This Form must be accompanied by the COC of the Incomplete vehicle AND the COC of the Completed vehicle. Upon receipt of the new Statistical Code an authorised dealer can register the vehicle on-line through the Revenue Online service. VEHICLE DETAILS VIN Birth Cert. No* CO2 g/km Original Statistical Code Make Model Total cost of modification in Euros including VAT NB a list of the invoices/receipts showing dates and amounts must be attached If not available attach explanation* DETAILS Incomplete Completed EU Vehicle Category Official Stamp of the Authorised Dealer No* of seats No* of seatbelt fittings EU Bodywork DoE Body Type Mass in service complete both No* of doors No* of windows Technically Permissible Maximum Laden Mass DECLARATION I hereby declare that - the modification details entered above are in accordance with the general definitions criteria for vehicle categorisation vehicle types and types of bodywork set out in Commission Regulation EU No* 678/2011 and the correct Type-Approval documentation for both the Incomplete vehicle and the Completed vehicle are attached* Date D D / M M / Y Y Y Y PPSN/Tax No* Signed On behalf of authorised dealer Block letters TAN Telephone Number s Central Vehicle Office notification to declarant The Statistical Code below has been allocated on the basis of information supplied by you. It must not be used for any other vehicle. Statistical Code Dealers are reminded that under S*I. 35 of the Road Traffic Control of Supply of Vehicles Regulations 1991 it is an offence to supply or offer to supply a motor vehicle which does not comply with Irish Road Traffic Regulations on the construction equipment and lighting of RPC003156ENWBL2 Characteristics. This completed document along with the original Type-Approval documentation of the Incomplete vehicle and the Type-Approval Document of the Completed vehicle should then be posted to FREEPOST Central Vehicle Office Revenue Commissioners Rosslare Harbour Co. Wexford or faxed to 053-9133779 to request the allocation of a new Statistical Code. This Form must be accompanied by the COC of the Incomplete vehicle AND the COC of the Completed vehicle. Wexford or faxed to 053-9133779 to request the allocation of a new Statistical Code. This Form must be accompanied by the COC of the Incomplete vehicle AND the COC of the Completed vehicle. Upon receipt of the new Statistical Code an authorised dealer can register the vehicle on-line through the Revenue Online service.

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