Vrt4 Form

A. N. Where applicable 34. OFFICER S SIGNATURE AND STAMP Phone No. 21. Enter Index Mark of County/Borough Form VRT4 Rev 6 SIGNATURE NOTES These notes are intended to be an aid to completing the form. In cases of difficulty consult with any official in your local Vehicle Registration Office VRO. DECLARATION FOR REGISTRATION OF A USED VEHICLE Other than a motor cycle Document Number Where applicable Before completing this form please read the notes overleaf* A. VEHICLE PARTICULARS Make Model and Version Colour s Body Type Fuel Type C. OPTIONS/EXTRAS 22. Options/Extras Fitted Chassis No* a b C O D E D. ACCOUNTING DETAILS DISTRIBUTOR DETAILS 23. Name of Distributor 6. Engine Capacity cc T. A. N* No* Invoice Ref* DEALER DETAILS 24. Name of Dealer Engine Number Number of Tel No* Fax. No* Please tick 10. Mileage Seats 11. Country of Origin 12. Country whence Consigned M a* c* KM Windows b. Sales Invoice Ref* Selling Price of Vehicle See Note 24 overleaf YES NO Type of Transaction Please Tick Country of Latest Registration Trade-in PAYER DETAILS 14. Previous Registrations Latest Registration Number Cash Date and Country of First Registration Month Year of Manufacture 25. Name Address VAT No* T. A. N* E* PAYER S DECLARATION 15. Statistical Code BLOCK CAPITAL declare that the particulars herein are true and accurate. as issued by the Revenue Commissioners Day Month Year Signature Date Receipt No* Where applicable F* OFFICIAL USE ONLY 17. Exemption Code 18. S*A*D* No* Month/Year Value as assessed by Revenue Official 27. Basic Price B. OWNER PARTICULARS 20. Surname/ Company Name 29. Total OMSP Tax Category Title Mr Ms etc* 31. Rate of Tax 33. Method of Payment Code First Name s Address Town/City County T. The number below refer to the corresponding box numbers on the form* In certain boxes codes are required - comprehensive lists of all codes are available from any VRO. SECTION A - VEHICLE PARTICULARS Only the manufacturer s marque is to be inserted here. Indicate whether transmission is manual or automatic by inserting M or A in sub-box a. Indicate whether right-hand or left-hand drive by inserting RHD or LHD in sub-box b. Either one colour or the appropriate combination should be entered CODE As appropriate e*g* saloon station wagon horse box van omnibus minibus open lorry etc* CODE diesel electricity steam etc* CODE* Enter cubic centimetres. A window is defined as including a sheet of glass or other material capable of admitting light whether or not encased in a frame or channel and whether or not forming a door or part of a door but does not include a windscreen or sun-roof* Complete and place tick in appropriate box. 11-12. Complete as appropriate including CODES* Place tick in appropriate box. The box Month and Year of Manufacture need only be completed in the vehicle was not previously registered* This code will be available from any VRO or the Central Vehicle Office Rosslare Harbour Co. Wexford telephone 053 61200 or fax 053 33730. Aufhorised Dealers who use the distance registration facility must insert the registration number issued by the Revenue Commissioners here.