Modification Application Form - Transport Tasmania
Modification Application Form - Transport Tasmania
Modification Application Form - Transport Tasmania
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PAGE 2 OF 7 MODIFICATION APPLICATION<br />
1.APPLICANT DETAILS<br />
FULL NAME: Mr, Mrs, Miss, Ms _________________________________________________________<br />
ADDRESS: __________________________________________________________________________<br />
________________________________________________Postcode___________________________<br />
DAYTIME<br />
CONTACT: Phone: ____________________________Mobile:_________________________________<br />
Email: _______________________________________________Fax:___________________________<br />
2. VEHICLE DETAILS<br />
Make____________________________Model_______________________Month/Year____________<br />
Registration No. __________________State_________ Existing body type: _______________________<br />
Approval Number shown on the vehicle compliance plate (post 1989 vehicles)_____________________<br />
Seating capacity: ___________________ Circle drive type 2WD/4WD/AWD/Other_________________<br />
Tare mass (unladen weight): ______________Kgs GVM (utes, vans, buses, trucks) _____________Kgs<br />
VIN/Chassis number<br />
Does the vehicle have Electronic Stability/Vehicle Stability or Driver Assist Technology? Yes/No.<br />
Is the vehicle fitted with an ABS braking system? Yes/No<br />
Is the vehicle fitted with SRS Airbags? Yes/No. How many?______. Circle location of all air bags.<br />
Drivers front, Passengers front, Drivers side, Passengers side, Rear, Other______________________<br />
3. NATURE OF VEHICLE MODIFICATION<br />
Type of modification (circle all applicable )<br />
• Engine replacement • Transmission replacement • Rebuild (includes from wrecks)<br />
• Brakes • Body change • Homebuilt (including hotrods)<br />
• Suspension • Seating/seat belts • Trailer<br />
• Steering • Changed GVM/GCM • Other (specify below)<br />
• Wheels and tyres • Chassis modification • Motorhome/Camper Conversion<br />
_____________________________________________________________________________________<br />
4.ENGINE<br />
ORIGINAL ENGINE (as fitted by vehicle manufacturer)<br />
Engine number______________________________Naturally aspirated/forced induction/fuel injected<br />
Number of cylinders_____________capacity _____________ cc/cu.in. Power __________ kW/bhp<br />
Fuel Type: Petrol/Diesel/Gas/Combination of____________________________________<br />
Produced by Vehicle Operations Branch<br />
10 Murray Street, Hobart Tas 7000 Revised 01/06/12<br />
Telephone: (03) 6233 5347 <strong>Modification</strong> <strong>Application</strong> <strong>Form</strong>.doc
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