Application For Designation As Inspection Facility
Download a blank fillable Application For Designation As Inspection Facility in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Application For Designation As Inspection Facility with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Highways and Public Works
Application For Designation as Inspection Facility
Periodic Commercial Vehicle Inspection Program
Application Information
COMPANY NAME:
__________________________________
ORIGINAL APPLICATION
RENEWAL APPLICATION
OWNER NAME:
__________________________________
TYPE OF INSPECTION DESIRED:
ADDRESS:
__________________________________
1. MOTOR VEHICLE 4500 kg
4. BUS GREATER
THAN 10 PASSENGERS
LICENSED GVW OR LESS
(INCLUDING DRIVER)
__________________________________
(NOT INCLUDING MOTORCYCLES)
2. MOTOR VEHICLE GREATER THAN 4500 kg
5.SCHOOL BUS
C
T I
: Y
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
LICENSED GVW (NOT INCLUDING BUS OR
POSTAL
SCHOOL BUS)
TERR:
__________________________________
CODE
3. TRAILER AND SEMI-TRAILER
Company Principals
N
A
M
E
P
O
I S
I T
O
N
A
D
D
R
E
S
S
L
C I
E
N
C
E
N
. O
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Inspection Facility
FACILITY NO.
________________________________________
(RENEWAL ONLY)
BUSINESS LICENCE ________________ EXPIRES ___________
yy/mm/dd
FACILITY
________________________________________
ADDRESS:
________________________________________
INDICATE ENDORSEMENTS
CITY:
________________________________________
1. AIR BRAKES
2. PRESSURE FUEL
POSTAL
TERR:
________________________________________
CODE
Staff List
PMVI INSPECTOR
MECHANICʼS NAME
CERTIFICATE NOS.
AUTHORIZATION NUMBER
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Equipment Check List
AUTOMOTIVE HAND
WHEEL ASSEMBLY
HOISTING OR
TORQUE WRENCH
TOOLS
REMOVAL DEVICE
LIFTING DEVICE
HEADLIGHT ALIGNMENT
BRAKE DRUM/CALIPER
TIRE DEPTH
TIRE PRESSURE
DEVICE
MEASURING TOOL
GAUGE
GAUGE
STEERING/SUSPENSION
FREE PLAY
MEASURING DEVICE
I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT.
DATE __________________
PERSON RESPONSIBLE
BUSINESS
FOR PROGRAM/FACILITY ___________________________________ TITLE ______________________ TEL. NUMBER ________________
SIGNATURE
PMVI Use Only
APPROVED
REJECTED
________________________________________________________
RECEIPT # ___________________ AMOUNT ______________
SIGNATURE/DATE
FACILITY # _______________________________________________
LICENCE EXPIRES ___________________________________
This information is being collected under the authority of the Motor Vehicles Act, R.S.Y. 2002 c.116, the National Safety Code Regulation, OIC 2007/168 and Part B of Standard 11 of the
National Safety Code. Your information will be used for administration of the Motor Vehicles Act, the National Safety Code Regulations and the National Safety COde. If you have questions
about why your information is being collected you may contact the Manager, National Safety Code, (867)667-5066, PO Box 2703 (W-17) Whitehorse, Yukon, Y1A 2C6.
YG (4155) NC2 REV 05/2013
Print
Clear
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Qba - Application For Designation As A Qualified Business For The Ar Year Application For Designation As A Qualified Business For The Form Qba Q
Financial
Form Qba - Application For Designation As A Qualified Business For The Qualified Equity And Subordinated Debt Investments Tax Credit - Virginia Department Of Taxation
Financial
Form Qba - Application For Designation As A Qualified Business For The Qualified Equity And Subordinated Debt Investments Tax Credit
Financial
Form Qba - Application For Designation As A Qualified Business For The Qualified Equity And Subordinated Debt Investments Tax Credit
Financial
Form Qba - Virginia Application For Designation As A Qualified Business For The Qualified Equity And Subordinated Debt Investments Tax Credit
Financial
Form Qba - Application For Designation As A Qualified Business For The Qualified Equity And Subordinated Debt Investments Tax Credit
Financial
Related Categories
Parent category: Legal