Commission Regulation (EU) No 63/2011Show full title

ANNEX I Standard format of the application for a derogation to be submitted by manufacturers meeting the criteria of Article 11(1) of Regulation (EC) No 443/2009

The electronic version of the application shall be sent to the following email address:

[e-mail]

1. Name, address and contact person for the manufacturer or group of connected manufacturers

Names of manufacturer	Postal address	Contact person name	Contact person email	Contact person telephone number

2. Eligibility criteria

2.1. Is the applicant part of a group of connected manufacturers?



YES (declaration set out in Annex III to be attached)



NO

2.2. Is the applicant part of a group of connected manufacturers but operates its own production facilities and design centre?



YES (declaration set out in Annex III to be attached; see point 2.3)



NO (see point 2.4 and 2.5)

2.3. Number of registrations in the Union if the application refers to an unconnected manufacturer or connected manufacturer that operates its own production facilities and own design centre:

2.3.1. Official figure in three calendar years preceding the date of application

Year
Number of EU registrations

2.3.2. Where the official figure referred to in point 2.3.1 is not available for the period referred to therein, an estimate based on verifiable data

Year
Number of EU registrations

2.3.3. Where the figures in point 2.3.1 and 2.3.2 are not available for that period, the figures for the last calendar year for which such data is available

Year
Number of EU registrations

2.4. If the application refers to a group of connected manufacturers please provide the following:

Names of manufacturer	Postal address	Contact person name	Contact person e-mail	Contact person telephone number

2.5. Number of registrations in the Union of a group of connected manufacturers if the application refers to a group of connected manufacturers and the applicant does not operate its own production facilities and own design centre:

2.5.1. Official figure in three calendar years preceding the date of application

Year
Number of EU registrations

2.5.2. Where the official figure referred to in point 2.5.1 is not available for the period referred to therein, an estimate based on verifiable data

Year
Number of EU registrations

2.5.3. Where the figures in point 2.5.1 and 2.5.2 are not available for that period, the figure for the last calendar year for which such data is available

Year
Number of EU registrations

3. Requested duration of the derogation

Number of calendar years (maximum 5)

4. Proposal for a specific emissions target calculated as fleet average for the period of derogation or separate specific emissions targets in case of yearly reductions (in g CO₂/km)

Year
Average specific emission target (g CO2/km)

5. Company specific information

5.1. Average specific emissions of CO₂ in 2007 if not included in Annex IV (or if not available in the following calendar year closest to 2007)

5.2. Number of employees in the calendar year preceding the date of application

5.3. Size of the production facility in square metres in the calendar year preceding the application

5.4. Sales volumes for five years preceding the date of application

Year
Sales volumes

5.5. Yearly turnover for five years preceding the date of application

Year
Turnover

5.6. Characteristics of the market

Information on planned products, not available on the market at the time of the application, should be provided in the confidential section of this application.

(a)

the vehicle characteristics;

(b)

the names and price ranges of directly competing vehicles in the year preceding the date of application;

(c)

the price list of vehicles that are to be covered by the derogation in the calendar year preceding the date of application or in the closest year to the date of application.

5.7. Brief description of the operational model of the production facility

CONFIDENTIAL SECTION OF THE APPLICATION

5.8. Net profit for five years preceding the date of application

Year
Net profit

5.9. R & D spending over five years preceding the date of application

Year
R & D spending

5.10. Net financial transfers to the parent company in case of connected undertakings during five years preceding the date of application

Year
Net transfers

6. Details of the passenger cars to be launched on the Union market for which the applicant will be responsible

6.1. Characteristics of the market

6.1.1. Vehicle characteristics;

6.1.2. Names and price ranges of directly competing vehicles in the year preceding the date of application;

6.1.3. Expected price list of vehicles to be covered by the derogation.

7. Applicant’s technological potential

7.1. List of CO₂ reducing technologies deployed in the applicant’s fleet in 2007;

7.2. Where the list referred to in point 7.1 is not available, the list for the following year closest to 2007;

7.3. In case of applicants planning to enter the Union market, the list referred to in point 7.1 should be provided for the first year of the derogation.

8. Applicant’s reduction programme

8.1. Timetable for deployment of CO₂ reducing technologies in the fleet;

8.2. Expected fleet average during the period of derogation:

8.2.1. Union registrations per year during the period of derogation

8.2.2. Expected average mass of vehicles to be launched on the Union market

8.2.3. Expected average specific CO₂ emissions of vehicles to be launched on the Union market

8.3. CO₂ reducing technologies to be deployed in the applicant’s fleet under the reduction programme;

8.4. The additional costs per vehicle version of the technologies to be deployed as part of the programme;

8.5. In the case of yearly targets, yearly improvement of specific CO₂ emissions of the vehicle versions for which CO₂ reducing technologies are introduced.