RSA/ADR 1

APPLICATION FOR ADR ROAD VEHICLE APPROVAL CERTIFICATE

Before filling in this application, please see notes at rear. Consult with your DGSA if unclear about any aspect.

(All relevant parts of this application must be completed, both for first and subsequent applications for all vehicles)
PART 1 (To be completed by all applicants)
))applicants)
1.

The Applicant

Name: ________________________________________________ Tel No: ____________________

Company: _______________________________________________email:_____________________
Address: __________________________________________________________________________________
2.

The Vehicle (Please tick appropriate box(es)

Is this the first application for this vehicle

YES

Method of Carrying
or Containing Load

NO

Rigid

Drawbar Trailer

Artic Tractor

Semi-Trailer

Box (closed) Body

Fixed Tank

Sheeted Body

Tank Container/Demountable

Battery Vehicle

Tank/Portable Tank/MEGC

Vehicle Type

Vac. operated Tank Vehicle

Registration No/Trailer Mark: _______________________ Chassis No: ______________
(Please enclose the vehicle Licensing or Registration Certificate, or Trailer Card, as appropriate)

Date of 1st Registration: ______________ D.G.V.W ________ TONNES D.G.C.W________TONNES

Make____________________________
3.

Body/Tank Make/Number: _______________________

Vehicle Owner (To be completed by all applicants)

Company: _________________________________________________________________________
Address: _________________________________________________________________________
___________________________________________Company email:__________________________
4.

The Test

1st Choice Test Centre ____________________________

5.

Date/Time: ____________________

Applicants Declaration

I declare that the information on this form is correct.

I enclose Cheque/Postal Order for the amount of 91.50 (I undertake to pay the remaining 91.50 directly to
the test centre on the day of the test).
Signed: _____________________ Name (BLOCK CAPITALS) _______________________________
Status (Transport Manager, etc) _________________________ Date ____________________________

PART II (To be completed by all applicants)

6.

ADR CATEGORY FOR WHICH CERTIFICATION IS REQUIRED

(Please tick the appropriate box(es))

B3 Certificate (Vehicle or trailer to be used in International or National Traffic)

13 Certificate (Vehicle or trailer to be used in national traffic only)

Vehicle category for which certification is required.

Type EX/II

For closed bodied or sheeted vehicles intended for the carriage of class 1 explosive
substance and articles.

Type EX/III

For a vehicle intended for the carriage of explosives substances and articles (Class 1).

Type FL

For a vehicle intended for the carriage of liquids having a flash-point of not more than
61oC (with the exception of diesel fuel complying with standard EN 590: 1993, gas
oil, and heating oil (light) UN No. 1202 with a flash-point as specified in standard
EN 590: 1993) or flammable gases, in tank-containers, portable tanks or MEGCs of
more than 3m3 capacity, fixed tanks or demountable tanks of more than 1 m3 capacity,
or a battery-vehicle of more than 1m3 capacity intended for the carriage of flammable
gases.

Type OX

For a vehicle intended for the carriage of hydrogen peroxide, stabilized or hydrogen
peroxide, aqueous solution stabilized with more than 60 per cent hydrogen peroxide
(Class 5.1, UN No. 2015) in tank-containers or portable tanks of more than 3 m3
capacity, fixed tanks or demountable tanks of more than 1 m3 capacity.

Type AT

For a vehicle, other than FL or OX, intended for the carriage of dangerous goods in
tank-containers, portable tanks or MEGCs of more than 3 m3 capacity, fixed tanks or
demountable tanks of more than 1 m3 capacity or a battery vehicle of more than 1 m3
capacity other than an FL Vehicle.

Do you intend carrying

a)
hydrogen
b)
carbon disulphide

YES
YES

NO
NO

Is the tank made of reinforced plastic.

YES

NO

TANK VEHICLE
Please state tank code according to ADR Agreement 2001 Chapter 4.3 (Column 12 of Table A of Chapter3.2)

Please state code for any special provisions relating to 6.8.4 of ADR Agreement 2001 (Column 13 of Table A of Chapter 3.2)

TANK VEHICLE/BATTERY VEHICLE

Is any of the substances to be carried classified with a (+) in Column 12 of Table A in Chapter 3.2 of the ADR Agreement
2001.

YES

NO

If Yes, please state below the name of the substance, the UN number and the packing group number

SUBSTANCE

UN NUMBER

PACKING GROUP NUMBER

___________

___________

_______________________

Note: Demountable tanks are tanks which cannot be removed from the carrying
vehicles when loaded.
Tank containers are tanks which are designed to be removed from the carrying
vehicle when loaded for transfer to another vehicle or mode of transport.
Battery vehicles are vehicles which carry an assembly of receptacles interconnected
by a manifold and permanently maintained in a frame.
EX II / EX III
Do you intend to carry any goods of Class 1 compatibility group J

YES

7.

NO

DOCUMENTATION

The following documentation and/or declarations are required with the application. Failure to
provide these could delay the application or lead to forfeiture of the fee. The RSA must at all
times hold copies of valid and up to date documentation/declarations for every ADR vehicle.
TYPE EX/II

Cab/Body and, if applicable, sheet declaration(s). See parts VI, VII and VIII.
N/A
Cab declaration provided by vehicle manufacturer.
Sheet declaration provided by manufacturer.
Body Declaration

YES

NO

TYPE EX/III

Brakes, Cab and body declarations. See parts III, VII and VIII.
N/A

YES

NO

Brake declaration provided by vehicle manufacturer.

Cab declaration provided by vehicle manufacturer.
Body declaration provided by manufacturer.
TYPE FL

Brake Declarations, Tank Approval Certificates and Combustion Heater

Declaration.
See parts III, IV and V.
N/A

YES

NO

Brake declaration provided by vehicle manufacturer.

Tank Type Approval Certificate
Tank Code and/or Product List provided.
Tank Initial Approval Certificate.
Tank Periodical Test Certificate.
Tank Leakproofness Test Certificate.
Combustion Heater Declaration
TYPE OX

Brake Declarations, Tank Type Approval Certificate, and Cab Declaration (if not
fitted with cab screen). See parts III, IV, and VII.
N/A
Brake declaration provided by vehicle manufacturer.
Tank Type Approval Certificate
Tank Code and/or Product List provided.
Tank Initial Approval Certificate.
Tank Periodical Test Certificate
Tank Leakproofness Test Certificate
Cab Declaration provided by Vehicle Manufacturer.

YES

NO

TYPE AT

Brake Declaration, Tank Type Approval Certificate.

See Parts III and IV.
N/A
Brake declaration provided by vehicle manufacturer.
Tank Type Approval Certificate.
Tank Code and/or Product List provided.
Tank Initial Approval Certificate.
Tank Periodical Test Certificate.
Tank Leakproofness Test Certificate.
.
Tank Lining Annual Condition Certificate (only required if
carrying Bromine)

YES

NO

PART III
8.

Braking Requirements from Type EX/III, FL, OX and AT Vehicles

A brake declaration completed by the manufacturer will be required for the following vehicles at the time
of first application for ADR inspection in the Republic of Ireland.
a) a motor vehicle first registered after 30 June 1993 with a maximum mass exceeding 16 tonnes.
b) a motor vehicle first registered after 30 June 1995 authorised to draw a trailer exceeding 10 tonnes.
c) a trailer manufactured after 30 June 1993 with a maximum mass exceeding 10 tonnes.
d) a motor vehicle exceeding a maximum mass of 16 tonnes, a motor vehicle capable of drawing a trailer
exceeding 10 tonnes or a trailer with a maximum mass exceeding 10 tonnes, first registered and presented
for approval on or after the 1st April, 2002.

DECLARATION to be completed by manufacturer.

NOTE:

A separate declaration from the manufacturer is acceptable provided it clearly relates to the vehicle
concerned.

I declare that:-

In the case of a motor vehicle referred to in (a), (b) or (d) above the vehicle is equipped with an
antilock braking system of category 1 according to UN ECE Regulations No. 13 Annex 13 or
the corresponding provisions of Directive 71/320/EEC.

In the case of a vehicle referred to in (a), (b) or (d) above the vehicle is equipped with an endurance
braking system (retarder) that fulfils the requirements of UN ECE Regulation No 13 Annex 5 (Type IIA
test), or of the corresponding provisions of EEC Directive 71/320/EEC, with a laden vehicle mass
comprising the laden mass of the motor vehicle and its authorised maximum towed mass but not
exceeding a total of 44 tonnes. (Where a vehicle is not authorised to tow a trailer this should be clearly
stated by the vehicle manufacturer).

In the case of a trailer referred to in (c) or (d) above the trailer is equipped with an antilock braking
system of category A according to UN ECE Regulation No 13 Annex 13 or to the corresponding
provisions of Directive 71/320/EEC.

Signed: _____________________ Name (BLOCK CAPITALS) _______________________________

Company __________________________

Status _________________

Date _____________

The following declaration will be required from the owner for every ADR application relating to the types of
vehicles referred to above.
Declaration to be completed by owner.
I declare that no repairs or alterations have been carried out which will invalidate the manufacturers declaration,
or which would affect the performance of either:
a. the antilock braking system, or
b. the endurance braking system
Signed: _____________________ Name (BLOCK CAPITALS) _______________________________
Company __________________________

Status _________________

Date _____________

PART IV

9.

Tank Certificates

The application must provide as appropriate (depending on whether a B3 or an I3 is required) the following with
the application: (Copies are acceptable but originals must be produced on the day of test).

a. Tank Type Approval Certificate.

b. Tank Code and/or Product List.
c. Tank Initial Approval Certificate.
d. Tank Periodical Test Certificate.
e. Tank Leakproofness Test Certificate.
f.

Tank Lining Annual Condition Certificate (only applicable if carrying Bromine)

PART V

10.

COMBUSTION HEATER HEAT EXCHANGER DECLARATION (only applicable to type FL vehicles)

A declaration completed by the manufacturer will be required at the time of first application for ADR inspection
in the Republic of Ireland.

DECLARATION to be completed by vehicle or combustion heater manufacturer. NB Dealer

declarations are not acceptable.

NOTE: A separate declaration from the manufacturer is acceptable provided it clearly relates to the vehicle.
I declare that:

The heat exchanger of the combustion heater fitted to the engine or cab of the type FL motor vehicle is
resistant to the reduced after-running cycle of 40 seconds for the time of its normal use.

Signed: _____________________ Name (BLOCK CAPITALS) _______________________________

Company __________________________

Status _________________

Date _____________

PART V I

II.

Sheet Declaration For Type EX/II Sheeted Vehicles

To be completed by the vehicle or sheet manufacturer or supplier. NOTE: A separate declaration from
the vehicle or sheet manufacturer or supplier is acceptable provided it clearly relates to the vehicle.
I declare that the sheet manufactured or supplied by ..
and if applicable marked with the following identification feature ..
is resistant to tearing and is made of impermeable material and not readily flammable as proven by
testing to the BI level in standard DIN 4102 or equivalent.
Signed: _____________________ Name (BLOCK CAPITALS) _______________________________
Company __________________________

Status _________________

Date _____________

PART V II

12.

Cab Declaration For All Type EX/II and EX/III Vehicles and those
OX Vehicles Not Equipped With A Metal Shield Behind The Cab.

Declaration(s) completed by the manufacturer (or modifier, if applicable) will be required for the
following vehicles at the time of first application for ADR inspection in the Republic of Ireland.
a. Type EX/II (explosives)
b. Type EX/III (explosives)
c. Type OX if not equipped with a metal shield behind the cab.
Declaration to be completed by manufacturer (or modifier, if applicable).
Note:

a separate declaration from the manufacturer/modifier is acceptable provided it clearly relates

to the vehicle.

I declare that:

Only material not readily flammable is used in the construction of the drivers cab.
This provision will be deemed to be met if, in accordance with the procedure specified in ISO standard
3795:1989, samples of the following cab components have a burn rate not exceeding 100 mm/min: seat
cushions, seat backs, safety belts, head lining, opening roofs, armrests, all trim panels including door,
front, rear, and side panels, compartment shelves, head restraints, floor coverings, sun visors, curtains,
shades, wheel housing covers, engine compartment covers, mattress covers and any other interior
materials, including padding and crash-deployed elements, that are designed to absorb energy on contact
by occupants in the event of a crash.

Signed: _____________________ Name (BLOCK CAPITALS) ______________________________

Company: ___________________ Status: ____________________

Date:__________________

The following declaration will be required from the owner for every ADR application relating to the type of
vehicle referred to above.

DECLARATION to be completed by owner

I declare that no repairs, modifications or paintings of the cab have been carried out in such a manner
as to invalidate the manufacturers/modifiers declaration.
Signed: _____________________ Name (BLOCK CAPITALS) ______________________________
Company: ___________________ Status: ____________________

Date: __________________

PART V III
13.

Body Declaration For Type EXII/EX/III Vehicles

A declaration completed by the manufacturer will be required at the time of first application for ADR
inspection in the Republic of Ireland.
Declaration to be completed by manufacturer.
Note: a separate declaration from the manufacturer is acceptable provided it clearly relates to the
vehicle.
I declare that in the case of a Type EXII vehicle or trailer:

No materials have been used in the construction of the body which would be likely to form dangerous
compounds with the substances carried.

Signed: _____________________ Name (BLOCK CAPITALS) ______________________________

Company: ___________________

Status: ____________________

Date: __________________

I declare that in the case of a Type EXIII motor vehicle or trailer:

the body is solidly constructed of not readily flammable materials and the materials used for the lining are
incapable of producing sparks.

the insulating and heat resisting properties of the body are at least equivalent to those of a partition consisting of a
metal outer wall lined with a layer of fire proofed wood 10mm thick, or the body is of a construction which ensure
no flame penetration of the wall or hot spots of more than 120oc on the inner wall surface will occur within 15
minutes from the start of a fire likely to occur from the operation of the vehicle.
No materials have been used in the construction of the body which would be likely to form dangerous compounds
with the substances carried.

Signed: _____________________ Name (BLOCK CAPITALS) ______________________________

Company: ___________________ Status: ____________________

Date: __________________

The following declaration will be required from the owner for every ADR application relating to the type
EXII/EXIII vehicle.
DECLARATION to be completed by owner
I declare that no repairs, modifications or painting of the body have been carried out in such a manner
as to invalidate the manufacturers declaration.
Signed: _____________________ Name (BLOCK CAPITALS) ______________________________
Company: ___________________ Status: ____________________

Date: __________________

Notes
General
1. Applicants must ensure that the application form for an ADR examination is properly
completed (e.g. tank code and special provisions code provided). You should consult
your D.G.S.A. if in doubt about any aspect of the form.
2. Applications should be made as early as possible and not less than 10 working days before
the inspection is required. Applications must be accompanied by copies only of the
necessary declarations and in the case of tank vehicles by current tank certificates, a tank
code and/or product list. Originals must be produced on the day of the examination. It will
be necessary to have passed a roadworthiness test within forty days of the confirmed
appointment date of the ADR examination. Evidence of this will be required to be presented
in the form of a certificate of roadworthiness or a pass statement of result on the day of the
ADR examination.
3. Separate applications must be made for each vehicle (i.e. motor vehicle, trailer or semitrailer) for which an ADR certificate is required.
4. Applications should be sent to, ADR Unit, Vehicle Standards Section, Road Safety
Authority, Moy Valley Business Park, Primrose Hill, Ballina Co. Mayo. The application
should be accompanied by a crossed cheque or postal order for 91.50 (payable to The
Road Safety Authority). The remaining fee of 91.50 must be paid directly to the
test centre on the day of the test. The payment of the test centres portion of the fee
is a matter between you and the test centre.
5. In some vehicle types it may be necessary for vehicles to be presented with covers
removed so that markings can be seen e.g. (battery master switch).
6. If you are not able to keep an appointment for an examination, let the inspection station
know as soon as possible fees may be forfeited for late cancellation or failure to
attend.
7. If this is not the first application for this vehicle, a photocopy of both sides of the current
or most recent ADR certificate must be enclosed with the application.
8. Following issue of a Certificate of Approval, the applicant should ensure that details on
the issued certificate corresponds with the approval requested in the application form.
9. Tank Vehicles
a)

Photocopies of the appropriate tank certificates should be sent with the

application. However, the originals must be produced at the time of the
examination. If an original has features which are not obvious on the copy
and which leads to a change having to be made to the prepared (ADR)
certificate, a retest fee may be payable before release of the new certificate.

b)

Before a B3 Approval Certificate can be processed, a copy of any previous

B3 certificate issued for the vehicle must be sent to The Road Safety
Authority.
11

c)

A declaration stating that the tank has been purged and rendered safe for
an ADR examination to be carried out must be presented at the test centre.

10. ADR Unit Contact Details:

ADR Unit
Vehicle Standards Section
Road Safety Authority
Moy Valley Business Park
Primrose Hill
Ballina
Co. Mayo.
Telephone: 096 25035
Email : [email protected]