Application Form To Replace A Vehicle Document Rf134 printable pdf download

Application Form To Replace A Vehicle Document Rf134

RF134

APPLICATION FOR REPLACEMENT DOCUMENTS

This application is for the following replacement document(s) (please tick)

1. Registration book (€12)

OFFICE USE ONLY

Vehicle Licensing Certificate (€12)

Date Received

2. Tax Disc (€6)

Fee Type

Office

Stamp

3. Trailer Licence Card (€6)

Fee Amount

4. Certificate of Roadworthiness

Light (€3)

Date Issued

Heavy (€7)

I hereby declare that the document(s) ticked above in respect of the Vehicle Registration Number

_______________________ (Index Mark if Trailer)

Make

Model

Has been Lost/Stolen/Destroyed or

The circumstances of the loss or destruction etc. are as follows:

I request that a replacement be issued to me on payment of the prescribed fee and I undertake to return the

original to the Licensing Authority if it should subsequently come into my possession.

Signed

Name (Block Letters)

Address

Date

Phone No.

NB An application is not complete until the verification below is completed

TO BE COMPLETED AT A GARDA STATION

The above named person reported the loss/destruction or ________________________ of the document

ticked above. I am satisfied, on the basis of the information available to the Gardaí at this station and the

position as elaborated on by the applicant, that this appears to be a valid application. The applicant has been

reminded that any person making a false declaration is liable to prosecution and on conviction to heavy

penalties.

Garda Signature

Garda Station Stamp

Date

Application Form To Replace A Vehicle Document Rf134