Vehicle Approval Application Form
     Heavy Vehicle National Law S23
     Heavy Vehicle (General) National Regulation S13
      CHECK LIST FOR SUBMITTING A PBS VEHICLE APPROVAL APPLICATION
      1  If vehicles are being added to an existing Vehicle Approval:
           - please highlight the new vehicles in bold; and
           - if known please provide previous Vehicle Approval reference number (previously Final 
           Approval)
           - if interchangeability of units is required please list ALL VIN’s in the supporting certificate. If 
            all units are not interchangeable provide a table showing the VIN’s that are interchangeable
      2  Identify Design Approval Vehicle Combination / Dimension Set, eg “Vehicle 4c”
      3  Please provide a drawing, a Design Approval drawing for Tier 1 or an “As Built” drawing for Tier 3, 
         due to jurisdictional access permit requirements. Please ensure that the drawing is legible and 
         shows the full prospective of the combination(s). Other drawings may be requested by the NHVR.
      4  Please provide certificate in both MS Word and PDF formats
      5  Please provide ALL drawings in JPEG or PDF format. 
      6  Please make sure that all vehicles you want to appear on VA are covered in this certification
      7  If during inspection anomalies have been identified please provide a sign-off from the applicable 
         Assessor:
           - if significant anomalies occur please supply an updated Part B from the Assessor
      CERTIFIER DECLARATION
      I hereby certify that the information in this Vehicle Approval application and the attached Certifier’s Certificate 
      any supporting documents are true and correct.  Giving false and misleading information is a serious offence 
      (Section 702 of the Heavy Vehicle National Law). Penalties apply.
      Name of certifier: 
      Address:
      Date:      __ __ / __ __ / __ __ __ __
      Signature:
     The NHVR is collecting your personal information to issue a PBS Vehicle Approval under Chapter 1 of the 
     Heavy Vehicle National Law and Section 13 of the Heavy Vehicle (General) National Regulation. We are 
     authorised under this Act to collect information we reasonably require to decide this application. 
     We may disclose protected information contained in your application for the purposes set out in section 
     727 of the Act to an entity (including a private or public sector entity) identified in that section. This can 
     include disclosure to an authorised employee or agent of the entity. We may disclose protected 
     information to a law enforcement agency, including a service provider authorised to enforce the Heavy 
     Vehicle National Law nationally. A police agency may disclose protected information disclosed to or 
     otherwise held by it to another police agency authorised to hold protected information.
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     Certifier’s Certificate
     Heavy Vehicle (General) National Regulator S13: 
      DESIGN APPROVAL CERTIFIER’S CERTIFICATE
      Application Number         Variation
      Design approval            Certificate Issue Number
      number
      Dimension Set 1            Dimension Set 2
      CERTIFIER’S COMMENTS (ANOMALIES)
      1
      2
      3
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      Details of Trucks(s) or Prime Mover(s) Inspected
      Make
      Model
      VIN(s)
      Engine Make  Model
      Transmission Make  Model
      Differential Make  Model  FD Ratio
      Suspension Make  Model (Steer)
      Suspension Make  Model (Drive)
      Tyres Size  Make  Model (Steer)
      Tyres Size  Make  Model (Drive)
      Brakes (Load Proportioning, ABS, ECB, etc)
      Tow Coupling Type  D Rating
      Wheelbase (mm)
      Vehicle Height (From the ground) (mm)
      Number of Axles
      ADR category
      GVM (kg)
      GCM (kg)
      Comments / Notes: 
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            Details of Dolly(s) Trailer(s) Inspected
           Type
           Make
           Model
           VIN(s)
           Suspension Make  Model
           Tyres Size  Make  Model
           Drawbar Length (mm)
           Coupling Type  D Rating
           Brakes (Load Proportioning, ABS, ECB, etc)
           Wheelbase (mm)
           Vehicle Height (From the ground) (mm)
           Number of Axles
           ADR category
           ATM (kg)
           Comments / Notes:
           INSPECTION DETAILS
           Certifier’s name                              Accreditation No
           Inspection location                           Inspection date
           CERTIFIER’S CERTIFICATION
           I certify that I have inspected this vehicle in accordance with the Vehicle Certification Rules and that the 
           vehicle has all the required physical characteristics as set out in the Vehicle Certification Information 
           document supplied to me by the Performance Based Standards Review Panel in relation to the vehicle.
           Signature _____________________________________               Date ____ /____ /______
                Page 4 of 4                         NHVR0050-202105                    National Heavy Vehicle Regulator
                                                                                                      www.nhvr.gov.au