ANNEX IVSupplementary provisions
ANNEX IV Templates for the EU type-approval certificate EU TYPE-APPROVAL CERTIFICATE EU TYPE-APPROVAL CERTIFICATE FOR AN ENGINE TYPE OR AN ENGINE FAMILY FOR NON-ROAD MOBILE MACHINERY IN ACCORDANCE WITH REGULATION (EU) 2016/1628 Identification of approval authority Communication concerning the: — EU type-approval ( 1 ) — extension of EU type-approval ( 1 ) — refusal of EU type-approval ( 1 ) — withdrawal of EU type-approval ( 1 ) of an engine type/ engine family ( 1 ) with regard to gaseous and particulate pollutant emission pursuant to Regulation (EU) 2016/1628, as last amended by (Commission Delegated) ( 1 ) Regulation …/… ( 1 ) ( 2 ) (of the European Parliament and of the Council) ( 1 ) EU type-approval number ( 3 ): … Reason for extension/refusal/withdrawal ( 1 ): … SECTION I 1.1. Make (trade name(s) of manufacturer): … 1.2. Commercial name(s) (if applicable): … 1.3. Company name and address of manufacturer: … 1.4. Name and address of manufacturer's authorised representative (if any): … 1.5. Name(s) and address(es) of assembly/manufacture plant(s): … 1.6. Engine type designation/engine family designation/FT ( 1 ): … 1.7. Category and sub-category of the engine type/engine family ( 1 ) ( 4 ): … 1.8. Emissions durability period category: Not Applicable/Cat 1/Cat 2/Cat 3 ( 1 ) 1.9. Emissions stage: V/ SPE 1.10. Engine for snow throwers ( 5 ): Yes/No ( 1 ) SECTION II 1. Technical service responsible for carrying out the test(s): … 2. Date(s) of the test report(s): … 3. Number(s) of the test report(s): … SECTION III The undersigned hereby certifies the accuracy of the manufacturer's description in the attached information document of the engine type/engine family ( 1 ) described above, for which one or more representative samples, selected by the approval authority, have been submitted as prototypes and that the attached test results apply to the engine type/engine family ( 1 ). 1. The engine type/engine family ( 1 ) meets/does not meet ( 1 ) the requirements laid down in Regulation (EU) 2016/1628. 2. The approval is granted/extended/refused/withdrawn ( 1 ) 3. The approval is granted in accordance with Article 35 of Regulation (EU) 2016/1628 and the validity of the approval is thus limited to dd/mm/yyyy ( 3 ) 4. Restrictions to validity ( 3 ) ( 6 ): … 5. Exemptions applied ( 3 ) ( 6 ): … Place: … Date: … Name and signature (or visual representation of an ‘advanced electronic signature’ according to Regulation (EU) No 910/2014, including data for verification): … Attachments: Information package Test report(s) Where applicable, the name(s) and specimen(s) of the signature(s) of the person(s) authorised to sign statement of conformity and a statement of their position in the company Where applicable, a completed specimen of a statement of conformity NB: If this model is used for EU type-approval of an engine as an exemption for new technologies or new concepts, pursuant to Article 35(4) of Regulation (EU) 2016/1628, the heading of the certificate shall read ‘PROVISIONAL EU TYPE-APPROVAL CERTIFICATE VALID ONLY ON THE TERRITORY OF … ( 7 )’.