ANNEX I

Appendix 2

Name of administration

EC Component type-approval certificate in respect of restraint devices for passengers for a type of two-wheel motor vehicleMODEL

Report No … by technical service … date …

EC Component type-approval No: … Extension No: …

1.

Trade mark or name of vehicle: …

2.

Type of vehicle: …

3.Name and address of manufacturer: …

4.Name and address of manufacturer’s representative (if any): …

5.

Date vehicle submitted for test: …

6.

EC Component type-approval granted/refused6

7.

Place: …

8.

Date: …

9.

Signature: …