Manufacturer's confirmation

We, the company	     	
	(Manufacturer or approval holder/authorized representative)	
	     	
	(Street)	
	     	
	(Country-Post Code-Place)	

confirm that, pursuant to 2002/24/EC (two-wheeled or three-wheeled motor vehicles), the vehicle with the following data from the corresponding fields of the Certificate of conformity (CoC):

Type (field 0.2):	     	
		
Variant/Version (field 0.2): 	     	
		
Class (field 0.4):	     	
		
Vehicle identification number (field 0.6):	     	
		
Approval number (field 0.7):	     	

no longer complies with the following individual legal acts as a result of new technical requirements:

Individual legal acts with expiry dates:	     	
		
	     	
		
	     	
		
	     	
		
	     	

The vehicle in question no longer complies with solely the legal acts stated above. 

     		     	
(Place, date)		(Signature(s) and company stamp)