Evaluation Form for National Small Series Type Approval (NSSTA) for
Category N2 & N3 vehicles
(For vehicles as a result of modification / conversion)
Items to be included with this form are:
-
-
Copy of the Whole Vehicle Type Approval certificate for original vehicle (if
applicable)
All EC/UN-ECE type approvals granted for the base vehicle (see page 6 &7), if
applicable.
Test reports for those areas for which the vehicle does not have an EC or UN-ECE
type approval.
Drawings, specifications, bill of materials, photographs describing the modification /
conversion (before, during and after).
Copy of the Certificate of Conformity (COC) for the original vehicle (if applicable).
Weighmaster’s certificate after conversion.
Applicant’s Name
Applicant’s Address
VIN
CO2 Emissions Value
(g/km) (if applicable)
No. of Employees
Telephone number
Fax number
Email
Web address
Applicant is a
subsidiary of
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0.
GENERAL
0.1.
Make trade name of manufacturer
0.2.
Type:
Variant:
Version:
0.3
Commercial name(s) if available:
0.4.
Means of identification of type, if marked on the
vehicle:
0.5.
Location of that marking:
0.6.
Category of vehicle:
0.7.
If applicable, classifications according to the
dangerous goods which the vehicle is intended to
transport:
0.8.
Name and address of manufacturer:
0.9.
Addresses of assembly plants:
1.
GENERAL CONSTRUCTION CHARACTERISTICS OF THE VEHICLE
1.1.
1.2.
Photographs and/or drawings of a representative
vehicle:
Number of axles and wheels:
1.3.
Number and position of steered axles:
1.4.
Powered axles (number, position, interconnection):
1.5.
Chassis, if any, overall drawing:
1.6.
Position and arrangement of the engine:
1.7.
Hand of drive: (left/right)
1.8.
Vehicle is equipped to be driven in right/left hand
traffic:
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2.
MASSES AND DIMENSIONS in kg and mm. Refer to drawings where applicable.
2.1.
Wheelbases
For two axle vehicles:
mm
For multi-axle vehicles:
mm
(More than to axles)
2.2.
Track of each steered axle:
mm
mm
2.3.
2.4.
2.5.
2.6.
Track of all other axles:
Axle 1:
mm
Axle 2:
mm
Axle 3:
mm
Axle 4:
mm
Range of vehicle dimensions (overall)
Length:
Length of the loading area:
Width:
Height (in running order):
mm
mm
mm
mm
For suspensions adjustable for height, indicate normal
running position:
mm
Mass of the vehicle with bodywork in running order:
Distribution of this mass among the axles:
(Axles numbered front to rear)
2.7.
2.8.
Technically permissible maximum laden mass stated
by the manufacturer:
Distribution of this mass among the axles:
(Axles numbered front to rear)
2.9.
Technically permissible maximum mass on each axle:
2.10.
Technically permissible maximum mass on each axle
group (if applicable):
Axle 1:
kg
kg. Axle 2:
kg.
Axle 3:
kg. Axle 4:
kg
kg.
Axle 1:
kg. Axle 2:
kg.
Axle 3:
Axle 1:
kg. Axle 4:
kg. Axle 2:
kg.
kg.
Axle 3:
kg. Axle 4:
kg.
kg.
kg.
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2.11.
2.12.
Vehicle is suitable for towing loads: (Yes / No)
Technically permissible maximum towable mass of the
motor vehicle in case of
Drawbar trailer:
Semi-trailer:
Centre-axle trailer:
Technically permissible maximum mass of the
combination:
Maximum mass of unbraked trailer:
kg
kg
kg
Maximum mass of braked trailer:
kg
2.15.
Technically permissible maximum static vertical
load/mass on the vehicles coupling point:
kg
3.
3.1.
POWER PLANT (in the case of a vehicle that can run either on petrol, diesel, or
also, in combination with another fuel, items shall be repeated
Manufacturer:
3.2.
Manufacturers engine code as marked on the engine:
2.13.
2.14.
kg
kg
Location of engine code:
3.3.
Internal combustion engine
3.4.
Working principle: positive ignition / compression
ignition, four stroke / two stroke:
3.5.
Number and arrangement of cylinders:
3.6.
Engine Capacity: …...cm3
3.7.
Maximum net power: …... kW at …... min -1
(manufacturers declared value)
Fuel: Diesel oil / petrol / LPG / NG / Ethanol / Other:
3.8.
3.9.
Location of the absorption coefficient symbol
(compression ignition engines only):
4.
TRANSMISSION
4.1.
Type (mechanical, hydraulic, electric, etc.)
4.2.
Gearbox
Manual / Automatic / CVT (Continuous Variable
Transmission):
4.3.
Maximum vehicle speed (in km/h):
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5.
SUSPENSION
5.1.
Level adjustment: (Yes/No)
5.2.
Air-suspension for driving axles: (Yes/No)
5.3.
Tyre / wheel combinations:
(for tyres indicate size designation, minimum load-capacity index, minimum speed category
symbol, suspension)
Axle (numbered
front to rear)
Tyre size and
Type
Load Index
Speed Rating
Twin or
Single
Suspension
Type (air, steel,
hydraulic etc)
Axle 1:
Axle 2:
Axle 3:
Axle 4:
5.4
Which tyre use condition applies: (2B, 2J, 2R etc)
5.5.
Upper and lower limits of rolling radii:
Axle 1:
mm
Axle 2:
mm
Axle 3:
mm
Axle 4:
mm
6.
STEERING
6.1
6.2.
Type of steering transmission (specify for front and
rear, if applicable):
Method of assistance, if any:
7.
BRAKES
7.1.
7.2
Is vehicle fitted with an anti-lock braking system:
(Yes/No):
What type of brake system is fitted:
7.3
Full Air
Air/Vacuum Hydraulic
Which axles have parking brakes fitted:
7.4
Axle 1
Axle 2
Is a transmission brake fitted: (Yes / No)




Hydraulic

Axle 3

Electric

Other
Axle 4


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8.
BODYWORK
8.1.
Seats
8.2.
8.3.
8.4.
8.5
Number:
Position and arrangement:
Number of seating positions:
Vehicle is fitted with a statutory plate in accordance
with EC Directive 76/114/EC: (Yes / No)
Table of compliance with IVA Requirements
Please indicate in the table below the EC or UN-ECE approvals and/or test reports in support of application for
Individual Vehicle Approval.
Where an EC approval or test report is not available for any item, an inspection or test will be required at an
Approved Test Centre (ATC) of your choice. Please see a list of ATCs at:
http://www.nsai.ie/Our-Services/Certification/Transport-Certification/Motor-Vehicle-ApprovalSchemes/Approved-Test-Centers.aspx
Item
No.
Subject
1
2
Noise
Emissions
3
Fuel tanks
Base
Directive
Number
70/157/EEC
70/220/EEC
2005/55/EC
70/221/EEC
Yes: 
No: X
UN-ECE
Regulation
Number
R51
R83
R49
R34, R67,
R110
R58
-R79
R11
R28
R46
9
Rear under run
Rear registration plate space
Steering effort
Door latches and hinges
Audible warning
Rear visibility (Indirect
Vision Devices)
Braking
10
11
13
Suppression (radio)
Diesel Smoke
Anti-theft and immobiliser
72/245/EEC
72/306/EEC
74/61/EEC
14
15
17
Protective Steering
Seat Strength
Speedometer and reverse
gear
Plates (statutory)
Seat belt anchorages
Installation of lighting and
74/297/EEC
74/408/EEC
75/443/EEC
R13,
R13H
R10
R24
R18, R97,
R116
R12
R17
R39
76/114/EEC
76/115EEC
76/756/EEC
-R14
R48
4
5
6
7
8
18
19
20
70/222/EEC
70/311/EEC
70/387/EEC
70/388/EEC
2003/97/EC
71/320/EEC
Yes: 
No: X
Test Report
Yes: 
No: X
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Item
No.
21
22
23
24
25
light signalling devices
Subject
Retro reflectors
End-outline front-position
(side), rear-position (side),
stop, side marker, daytime
running lamps
Direction indicators
Rear registration plate lamps
Headlamps (including
bulbs)
Base
Directive
Number
76/757/EEC
76/758/EEC
76/759/EEC
76/760/EEC
76/761/EEC
26
27
28
29
30
31
33
34
Front fog lamps
Towing hooks
Rear fog lamps
Reversing lamps
Parking lamps
Seat belts
Identification of controls
Defrost / demist
76/762/EEC
77/389/EEC
77/538/EEC
77/539/EEC
77/540/EEC
77/541/EEC
78/316/EEC
35
Wash / wipe
Vehicles shall
be fitted with
an adequate
windscreen
defrosting
and demisting
Vehicles shall
be fitted with
an adequate
windscreen
washing and
wiping
devices.
36
39
40
41
45
46
Heating systems
CO2/Fuel consumption
Engine power
Diesel emissions
Safety glass
Tyres
2001/56/EEC
80/1268/EEC
80/1269/EEC
88/77/EEC
92/22/EEC
92/23/EEC
48
49
50
Masses and dimensions
External projections of cabs
Couplings
97/27/EC
92/114/EEC
94/20/EC
Yes 
No X
UN-ECE
Regulation
Number
R3
R7
Yes 
No X
Test Report
Yes 
No X
R6
R4
R1, R5,
R8, R20,
R31, R37,
R98, R99,
R112,
R123
R19
-R38
R23
R77
R16
R121
--
--
R122
R101
R85
R49
R43
R30, R54,
R117
-R61
R55, R102
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