Period: A - to Valid to FIA Class:

Similar documents
Period: GR to 1971 valid to FIA Class: Fv/1

Period: J to 1985 valid to FIA Class: CT38

How to issue FIA Historic Technical Passports Regulations for ASNs

5TH CATEGORY - HISTORIC RACING. GROUP Nc APPROVED VEHICLE SPECIFICATION

5TH CATEGORY - HISTORIC RACING. GROUP Sb APPROVED VEHICLE SPECIFICATION

5TH CATEGORY - HISTORIC RACING. GROUP Nb APPROVED VEHICLE SPECIFICATION

5TH CATEGORY - HISTORIC RACING. GROUP Sc APPROVED VEHICLE SPECIFICATION

GROUP Sc 5TH CATEGORY - HISTORIC RACING APPROVED VEHICLE SPECIFICATION

CAMS 5TH CATEGORY - HISTORIC RACING. GROUP Sb APPROVED VEHICLE SPECIFICATION

5TH CATEGORY - HISTORIC RACING. GROUP Sb APPROVED VEHICLE SPECIFICATION

SECTION 1 - CHASSIS 1.1 CHASSIS FRAME

5TH CATEGORY - HISTORIC RACING. GROUP Nb APPROVED VEHICLE SPECIFICATION

Motorsport UK Vehicle Passport Application Guidance Notes

Modified Article Date of Application Date of Publication

2018 Lebanese Drift Championship Technical Regulations

5TH CATEGORY - HISTORIC RACING. GROUP Nc APPROVED VEHICLE SPECIFICATION

SWIFT SPORT RALLYCROSS CHAMPIONSHIP. Technical Regulations

Period Specification of Dampers

5TH CATEGORY - HISTORIC RACING. GROUP Nc APPROVED VEHICLE SPECIFICATION

5TH CATEGORY - HISTORIC RACING. GROUP Nc APPROVED VEHICLE SPECIFICATION

IMPORTANT INFORMATION ABOUT THIS APPLICATION

2019 CAMS MANUAL OF MOTOR SPORT

5TH CATEGORY - HISTORIC RACING. GROUP Nb APPROVED VEHICLE SPECIFICATION

Guidelines for Safety Structure Homologation / Approval

TOYOTA 86 RACE SERIES

2016 FIM CEV REPSOL Moto2 TM TECHNICAL RULES (UPDATED: )

2019 CAMS MANUAL OF MOTOR SPORT

2014 FORMULA 4 HOMOLOGATION REGULATIONS

MSA Junior Rallycross Championship. Technical Regulations

2018 CAMS MANUAL OF MOTOR SPORT

PART 2 SCHEDULE SP Sport Saloons Cup Race Series TECHNICAL REGULATIONS

2009 FORMULA TWO TECHNICAL REGULATIONS

Chapter One - Technical Regulations. Chapter Two - Crack-testing and Repairs to Composite Parts

2010 FORMULA TWO TECHNICAL REGULATIONS

2018 Technical Regulation for Indian Junior Touring Cars (TC-2)

CEV BUCKLER 2012 TECHNICAL RULES Moto3

The new 911 GT3 R. Challenger.

1. GENERAL PRINCIPLES

COMPONENT HOMOLOGATION POLICY AND PROCEDURE

INTERNATIONELLA TEKNISKA BESTÄMMELSER Appendix K I ÅR, IDAG, I MORGON

TECHNICAL FORM SEAT LEON CUP RACER MK3 1. GENERAL. Homologation N. Extension N. Model: LEON CUP RACER MK3. Make: SEAT SPORT

Department of Transport and Confederation of Australian Motor Sport DEDICATED RALLY CAR PROGRAM

FORMULA RENAULT SERIES-TECHNICAL REGULATIONS

Press Release May 15, 2015 No. M 55/15

APPENDIX C Mini Motocross Homologation (Off Road)

SUPER BIKE SUPER SCOOTER SRV 850

PART 2 SCHEDULE GTR GTRNZ Race Series TECHNICAL REGULATIONS

WPMC HISTORIC CARS TECHNICAL RULES Pre-1990 FOR 2019 (161727/144) WPMC/HCTR/PRE90/2019 Rev C. Action Name Function Date

X30 CHALLENGE INTERNATIONAL TECHNICAL REGULATIONS 2017 PART 2 ENGINES

CAPE HELL DRIVERS MOTOR CLUB KAAPSE JAAGDUIWELS MOTORKLUB

Press Release November 28, 2018

ASO HOMOLOGATION - TECHNICAL REGULATIONS FOR T4.2 TRUCKS FROM 1st of JANUARY 2018 ONWARDS

REAL FEDERACIÓN ESPAÑOLA DE AUTOMOVILISMO

2019 CAMS MANUAL OF MOTOR SPORT

NATIONAL HOMOLOGATION FORM KARTING ENGINE

NATIONAL HOMOLOGATION FORM KARTING ENGINE

Mondello Ford Fiesta ZETEC Championship 2016 TECHNICAL REGULATIONS

DRAFT Technical Regulations for Trucks result of La Paz/Breda TWG V

ENGINE. Manufacturer IAMEs.p.a. Category. Homologation Period. Pages 16. Model, Type SIGNATURE AND STAMP OF AKA SIGNATURE AND STAMP OF APPLICANT

Regulations ARC - Alfa Romeo Challenge- 2018

SPEED EVENT CHAMPIONSHIP CLASSES

SPECIFICATIONS OF AUTOMOBILES

Appendix 3. LHMC Supercar Technical Regulations 2015 FINAL. 1 of 5

Excerpt from Limited Sprintcar Association of WA Constitution, Rules and Specification you may request the booklet from the LSA.

THE VETERAN CAR CLUB OF AUSTRALIA (VIC.) VETERAN DATING APPLICATION AND VEHICLE RECORD FORM

MONOPOSTO RACING Class Specification Formula Vee REVISED March 2008

DRAFT VTS. Approved for Racing

TECHNICAL REGULATIONS 2016

} Rev.1/Add.12/Rev.6/Amend.4

SCRUTINEERS' NEWSLETTER ISSUE

Porsche Carrera Cup Germany 2018

TECHNICAL REGULATIONS Rally Cup

ŠKODA KODIAQ SPORTLINE Petrol engines

Please note that any machine outside the specifications may be put into a consolation class. This class will not receive any school points nor prizes.

ŠKODA KODIAQ SCOUT Diesel engines

2018 Australian Rallycross Series - Vehicle Regulations 2018 RXA SERIES (AUSTRALIAN RALLYCROSS SERIES)

Modified Article Date of Application Date of Publication

TECHNICAL REGULATIONS 2019

Lola B07/90 Sports 2000 Product Information

TECHNICAL REGULATIONS RACING CLASSES. i. All vehicles must be a recognised model from a vehicle manufacturer.

Fall. Competition Rules for 2019 Version 2

ŠKODA KODIAQ Diesel engines

FEDERATION INTERNATIONALE DE L'AUTOMOBILE JAPAN AUTO MOBILE FEDERATION. Groupe Group A / B / N

LMP3 Prototype overview

2.1, Class 1 Karts Specific Regulations: Class 1 refers to Direct Drive Karts of a designed cubic capacity of 100cc.

2018 Technical Regulation for Indian Touring Cars (TC-1)

Modified Article Date of Application Date of Publication. 12.3(a)(viii) (b)(vi)

Initial Gold Medallion Application

RADICAL RXC COUPE SERIES

Appendix K to the International Sporting Code

Diesel engines Bore Stroke [mm mm] Max. engine performance/revs [kw at rpm]

2018 NATIONAL TECHNICAL REGULATIONS FOR PRE-1980 HISTORIC SALOON CARS MSA NORTHERN REGIONS CIRCULAR NR33/18 (161390/144)

Chapter 2 EARLY POSTWAR CARS. 8HP, 12HP and 14HP. TRIUMPH & STANDARD CARS 1945 to 1984 A Pictorial History

TROPHY CLIO R3T FRANCE. Technical Regulations - Update 28/02/17 - FFSA C29 approved - 1/12

Unit HV04K Knowledge of Heavy Vehicle Chassis Units and Components

Ford Capri to FIA RS2600 Group 2 Specification Registration Number: XMP 782G

CANADIAN SPECIFICATIONS

RMS CONDITIONAL REGISTRATION SCHEME HISTORIC (CRS-H) RULES FOR MEMBERS. Mustang Owners Club Australia (N S W) Inc.

DRAFT VTS. Approved for Racing

Modified Article Date of Application Date of Publication 27/02/ /02/2018

Transcription:

Page1 Red and/or black dot entries: HISTORIC TECHNICAL PASSPORT VALID IN: & & This Technical Passport is not a certificate of authenticity, nor does it in any way verify the history of the car or its constituent parts. The FIA merely certifies that the required information gathered and confirmed by the ASN at the date of the inspection, is sufficient for the car to be eligible to compete in FIA-sanctioned competitions for historic vehicles. Neither the FIA nor the ASN certifies or takes responsibility for the accuracy of the items shown below as "represented" as those were provided by the Applicant (as detailed in Page 24), on behalf of the owner, based upon his best available knowledge and are not verifiable by the ASN and/or the FIA. Issuing ASN: Motorsport UK Form Number: Category: Single-Seater Racing Car Period: A - to Valid to 31.12. FIA Class: The original of this document was filled in by the Applicant and verified by the ASN in accordance with Appendix "K" to the FIA International Sporting Code, for cars taking part in historic competitions. This certified copy of the original form remains the property of the FIA and, if replaced with a new form, must be returned to the issuing ASN which holds the original. During the whole competition the car must conform to all the declarations of this HTP. Make represented: Model represented: Year of specification: FIA identity No. : Engine type: Engine capacity: cm 3 corrected: cm 3 FIA homologation form number (if applicable): Number of relevant valid pages of homologation form: COLOUR PHOTOGRAPH OF THE CAR IN ITS PRESENT FORM ¾ front view of the right side of the complete car Each page of this form, as well as the edge of each photograph, must bear the stamp of the issuing ASN We,, have checked the information given on this form up to and including page 24 and confirm that to the best of our reasonable knowledge and belief as of today, the car complies with the period specification of the make and model represented. Date: Signature and stamp: Name and status of signatory: FIA HTP vignette JOHN RYAN, Technical Director For and on Behalf of MOTORSPORT UK

Page2 COLOUR PHOTOGRAPH OF THE CAR IN ITS PRESENT FORM ¾ rear view of the left side of the complete car In case of homologated car only: if extensions of the original homologation form are used (in accordance with Appendix K), their numbers must be entered below: In case of homologated car bodywork may only be altered on Competition Grand Touring Cars (GTS) before Period G and on Competition Touring and GTS cars from Period G onwards according to Appendix J of the period. For the avoidance of any doubt there must be attached to this document evidence of Period Specification of changed bodywork according to Appendix K, over stamped by the issuing ASN as authorisation. For non-homologated cars and homologated cars with non-standard bodywork, a period picture of the model has to be shown below. PERIOD IMAGE OF BODYWORK OF ORIGINAL CAR Homologated cars. For others also display a picture from period, especially as it can authenticate the car livery. Period image. Event: ; date of the event: IMPORTANT: If this model has no International History, tick this box:

Page3 Signatory ASN: 1.1 CHASSIS FRAME 1 CHASSIS, SUSPENSION [a] Is the car fitted with a chassis to the period specifications? yes no [b] Clarification: [c] [d] Construction (girder, tubular, monocoque, etc.): Materials: 1.2 FRONT SUSPENSION [a] Is the suspension as per the period specifications and dimensions? yes no [b] Clarification: [c] Type of suspension (rigid axle, wishbones, de Dion, etc.): [d] [e] Type of springs (coil, leaf, torsion bar, etc.): Type of dampers (friction, lever, telescopic, etc.): [f] Are the dampers adjustable? yes no [g] If yes to [f], state the number of adjusters per damper: [h] Material of the dampers: Steel Aluminium [i1] Is the geometry of suspension adjustable? yes no [i2] Is the height of suspension adjustable? yes no [j] If yes to [i1] and/or [i2], specify the method (Uniball joints, different mountings, etc.): i1: i2: [k] Is it fitted with an anti-roll bar? yes no [l] If yes, is this bar adjustable? yes no [m] Are sensors fitted? yes no [n] If yes, list the sensors:

Page4 COLOUR PHOTOGRAPH OF THE FRONT SUSPENSION Side view, wheel removed, the braking system and suspension must be clearly visible In case of drum brakes the drum has to be removed and seen on the picture Taking the two pictures into account, all elements of the suspension assembly must be visible. COLOUR PHOTOGRAPH OF THE FRONT SUSPENSION behind the braking system in longitudinal axis of the car

Page5 1.3 REAR SUSPENSION [a] Are the suspension and dimensions as per the period specifications? yes no [b] Clarification: [c] Type of suspension (rigid axle, wishbones, de Dion, etc.): [d] [e] Type of springs (coil, leaf, torsion bar, etc.): Type of dampers (friction, lever, telescopic, etc.): [f] Are the dampers adjustable? yes no [g] If yes to [f], state the number of adjusters per damper: [h] Material of the dampers: Steel Aluminium [i1] Is the geometry of suspension adjustable? yes no [i2] Is the height of suspension adjustable? yes no [j] If yes to [i1] and/or [i2], specify the method (Uniball joints, different mountings, etc.): i1: i2: [k] Is it fitted with an anti-roll bar? yes no [l] If yes, is this bar adjustable? yes no [m] Are sensors fitted? yes no [n] If yes, list the sensors:

Page6 COLOUR PHOTOGRAPH OF THE REAR SUSPENSION Side view, wheel removed, the braking system and suspension must be clearly visible In case of drum brakes the drum has to be removed and seen on the picture Taking the two pictures into account, all elements of the suspension assembly must be visible. COLOUR PHOTOGRAPH OF THE REAR SUSPENSION behind the braking system in longitudinal axis of the car

Page7 2 ENGINE 2.1 ENGINE [a] Is the engine as per the period specifications for this chassis? yes no [b] Clarification: [c] Is the position of the engine as per the period specifications? yes no [d] Clarification: [e] Is the cylinder block cast using the period specification material and dimensions? yes no Specify material: [f] Clarification: [g] Is the cylinder head cast using the period specification material and dimensions? yes no Specify material: Casting number: [h] Clarification:: [i] Make: Casting number of the block: [j] Year of manufacture: Operating method: Four-stroke cycle [k] Number of cylinders: Configuration (straight, V, etc.): [l] Bore: original: mm Stroke: original: mm actual: mm actual: mm [m] Engine capacity: original: cm 3 actual: cm 3 [n] Number of intake ports: Number of plugs per cylinder: Number of exhaust ports: Number of valves per cylinder: Number of transportation port (in case of two stroke engines): Number of rotors (in case of wankel/rotary engine): [o] Are the valve sizes as per the period specification? yes no [p] Clarification: [q] Are sensors fitted? yes no [r] If yes, list the sensors:

Page8 2.2 IGNITION [a] Is the system as per the period specifications? yes no [b] Clarification: [c] Type (magneto, breaker/coil, etc.): [d] If the ignition is electronic, specify the make and principle: [e] Are sensors fitted? yes no [f] If yes, list the sensors: 2.3 FUEL FEED [a] Are the make, type and number of carburettors / injections as per the period specifications? yes no [b] Clarification: [c] Carburettor: Number: Make: Type: ø of venturi in mm: [d] Injection: Make: Type: [e] If an air restrictor is fitted, diameter of the restrictor: mm [f] If supercharged, is the supercharger as per the period specifications? yes no [g] Clarification: [h] Supercharger: Make: Type: Number: [i] If an air cooler is fitted, is it as per the period specifications? yes no [j] Clarification: [k] Are sensors fitted? yes no [l] If yes, list the sensors:

Page9 2.4 FUEL SYSTEM [a] Is the fuel system as per the period specifications? yes no [b] Clarification: [c] Type of fuel feed (gravity, mechanical pump, electric pump, etc.): [d] Is a fuel cooler fitted yes no [e] Is the fuel tank as per the period specification location? yes no Does it comply with Appendix K? yes no [f] Clarification: [g] Are sensors fitted? yes no [h] If yes, list the sensors: 2.5 LUBRICATION [a] Is the system as per the period specifications? yes no [b] Clarification: [c] Type (wet sump, dry sump, etc.): [d] Is an oil cooler fitted? yes no [e] If yes, is the cooler as per the period specifications? yes no [f] If no, specify and justify the changes in relation to the period specification: [g] Is a main circuit oil filter fitted (pre-war cars only)? yes no [h] Are sensors fitted? yes no [i] If yes, list the sensors:

Page10 COLOUR PHOTOGRAPH OF THE ENGINE showing all the engine bay from the left side COLOUR PHOTOGRAPH OF THE ENGINE showing all the engine bay from the right side

Page11 3 TRANSMISSION 3.1 GEARBOX [a] Is the gearbox as per the period specifications? yes no [b] Clarification: [c] Make: Type: [d] Number of forward gears: reverse gear: yes no [e] Number of teeth (for homologated cars only): 1st gear: 2nd gear: 3rd gear: 4th gear: 5th gear: 6th gear: Constant: alternatives listed in section 9 [f] Is an oil cooler fitted? yes no [g] If yes, is it as per the period specifications? yes no [h] Are sensors fitted? yes no [i] If yes, list the sensors: 3.2 FINAL DRIVE [a] Driven wheels: Front: Rear: [b] Drive method (shaft, chain, etc.): [c] Is the final drive ratio as per the period specifications? yes no [d] Specify the number of teeth used: [e] Specify the other number of teeth available as period specifications: - - - - - - - - - - - - - - - - [f] Is the differential a limited slip differential? yes no [g] If yes: Make: Model: System: [h] Is an oil cooler fitted? yes no [i] If yes, is it as per the period specifications? yes no [j] Are sensors fitted? yes no [k] If yes, list the sensors:

Page12 4.1 BRAKES 4 BRAKES AND STEERING [a] Is the braking system as per the period specifications? yes no [b] Clarification: [c] Actuation (cable, rod, hydraulic, etc.): Front: Rear: Other option: [d] Is the braking system assisted? yes no Other option: [e] Specify the system: [f] Make: Front: Rear: [g] If drum brakes: Drum diameter Front: mm Rear: mm Other: mm Shoe width Front: mm Rear: mm Other: mm [h] If disc brakes: Disc diameter Front: mm Rear: mm Max. disc thickness Front: mm Rear: mm Ventilated disc: Front: yes no Rear: yes no Callipers: Material at front: Number of pistons per front calliper: Material at rear: Number of pistons per rear calliper: [i] Are sensors fitted? yes no [j] If yes, list the sensors: 4.2 STEERING [a] Is the steering as per the period specifications? yes no [b] Clarification: [c] Type (rack and pinion, worm and roller, etc.): [d] Is the steering assisted? yes no [e] Specify the system: [f] Are sensors fitted? yes no [g] If yes, list the sensors:

Page13 5.1 WHEELS 5 WHEELS [a] Are the wheels as per the period specifications? yes no [b] Clarification: [c] Are the wheels in multiple parts? yes no [d] Are the diameter and the width of the wheels as per the period specification? yes no [e] Clarification: [f] Type and material (wire, pressed steel, alu alloy, magnesium alloy, etc.): Front: Rear: [g] Diameters / widths of rims at the front (specify the units: inches or millimetres): 1. Diameter: " Width: " 2. Diameter: " Width: " 3. Diameter: " Width: " 4. Diameter: " Width: " [h] Diameters / widths of rims at the rear (specify the units: inches or millimetres): 1. Diameter: " Width: " 2. Diameter: " Width: " 3. Diameter: " Width: " 4. Diameter: " Width: " [i] Are sensors fitted? yes no [j] If yes, list the sensors: 6.1 BODY 6 BODYWORK, LIGHTING [a] Is the body to the original specification? yes no [b] If no, is the body as per the period specifications? yes no [c] Clarification: [d] Is all the material of the body as per the period specifications? yes no [e] Main material: If other material used specify material and body parts: [f] Type (single-seater, coupé, etc.): [g] Number of seats: [h] Number of doors: 6.2 AERODYNAMIC DEVICES (cars built after 1965 only) [a] Are these devices as per the period specifications? yes no [b] Clarification: [c] Measurements see extension AERODYNAMIC DEVICES (MEASUREMENTS)

Page14 6.3 LIGHTING [a] Is the lighting as per the period specifications? yes no [b] If no, specify and justify the changes in relation to the period specification: [c] Is generator fitted? yes no [d] If yes, type: dynamo alternator other, specify and justify: 7.1 DIMENSIONS 7 DIMENSIONS [a] Wheelbase: left: mm right: mm [b] Only for homologated cars from Period G2 onwards, body width at centre line of axles: Original front : mm Current front : mm Original rear: mm Current rear: mm [c] For all other cases, track (track measured between the centres of the tyre treads): Original front : mm Current front : mm Original rear: mm Current rear: mm [d] Minimum weight: kg [e] Clarification: 8 DRAWINGS AND/OR PICTURES If necessary, drawings and/or pictures of the aerodynamic devices, suspension, etc If necessary, list of alternatives (gearbox ratios, etc) 9 ADDITIONAL PIECES OF INFORMATION

Page15 Signatory ASN: 10 EXTENSION MANDATORY PHOTOS COLOUR PHOTOGRAPH OF THE CAR IN ITS PRESENT FORM Front view of the the complete car COLOUR PHOTOGRAPH OF THE CAR IN ITS PRESENT FORM Rear view of the complete car

Page16 COLOUR PHOTOGRAPH OF THE CAR IN ITS PRESENT FORM lateral view of the complete car COLOUR PHOTOGRAPH OF THE DASHBOARD

Page17 COLOUR PHOTOGRAPH OF THE COMPLETE BOOT COLOUR PHOTOGRAPH OF THE UNDER FLOOR

Page18 COLOUR PHOTOGRAPH OF THE GEAR BOX COLOUR PHOTOGRAPH OF THE FINAL DRIVE

Page19 11 DOCUMENTARY REFERENCES Draw up a list of the technical and descriptive references to the car found in documents (books, periodicals, etc.) contemporary with its construction.

Page20 12 EXTENSION AERODYNAMIC DEVICES (MEASUREMENTS) DIMENSIONS (TOLERANCE FOR ALL DIMENSIONS: +/-1%) [A] [B] [C] [D] [E] mm mm mm mm mm

Page21 NUMBER OF WINGS: DIMENSIONS (TOLERANCE FOR ALL DIMENSIONS: +/-1%) WING 1 WING 2 WING 3 WING 4 [A] mm [A] mm [A] mm [A] mm [B] mm [B] mm [B] mm [B] mm [C] mm [C] mm [C] mm [C] mm [D] mm [D] mm [D] mm [D] mm [E] mm [E] mm [E] mm [E] mm [F] mm [F] mm [F] mm [F] mm

Page22 DIMENSIONS (TOLERANCE FOR ALL DIMENSIONS: +/-1%) [A] mm [B] mm [C] mm [D] mm [E] 50 mm min. [F] mm [G] mm [H] mm [I] mm [J] mm [K] mm [L] mm [M] mm DIMENSIONS (TOLERANCE FOR ALL DIMENSIONS: +/-1%) [A] mm [B] mm [C] mm [D] mm max. [E] 50 mm min. [F] mm min. [G] mm [H] mm [I] mm [J] mm

Page23 1.1 ROLL OVER PROTECTION SYSTEM 13 EXTENSION ROLL OVER PROTECTION SYSTEM PART 1 [a] System in accordance with: Period Specification (App J)[non homol. cars only] 1.2 FIA HOMOLOGATED SYSTEM [a] If on FIA homologation form: Name of manufacturer: Homologation number of the form: Number of the homologation extension: N.B.: A copy of the extension must be attached to the HTP. 1.3 ASN CERTIFIED SYSTEM [a] If certified by an ASN: Certificate / Test report number: Name of the ASN: N.B.: A copy of the certificate must be attached to the HTP. 1.4 APPENDIX K SYSTEM (SELF MADE) [a] Main/Lateral bar Front bar Diagonals Other struts Cross braces Outer diameter (mm) Wall thickness (mm) [b] Material specification: [c] Drawing numbers according to App. K - App. VI (including the basic drawings and drawings of all options used): 1.5 PERIOD SPECIFICATION SYSTEM [a] Main/Lateral bar Front bar Diagonals Other struts Cross braces Outer diameter (mm) Wall thickness (mm) [b] Material specification: [c] Drawing numbers according to App. K - App. VI (including the basic drawings and drawings of all options used): [d] Number of mounting points to bodyshell / chassis: 1.6 FURTHER INFORMATION, IF NECESSARY:

Page24 14 TECHNICAL REGULATIONS - The car must comply with the technical regulations for Group of Appendix J 19. - Or, the car must comply with the following technical regulations: (from 19 ). The regulations of current Appendix K have priority. 15 APPLICANT S DECLARATION I AS OWNER OR PERSON WHO HAS BEEN DULY AUTHORISED BY THE OWNER TO SUBMIT THE APPLICATION FOR THE HTP, CERTIFY (I) THAT THE INFORMATION GIVEN IS CORRECT, AND (II) THAT THE AUTHORISING ASN WILL BE IMMEDIATELY NOTIFIED SHOULD ANY CHANGES BE MADE TO THE CAR AFTER THE PRESENT HTP HAS BEEN ISSUED. I FURTHERMORE ACKNOWLEDGE, THAT SHOULD THE CAR NOT CONFORM TO THE SPECIFICATIONS SET FORTH HEREIN AT ANY TIME AFTER ISSUANCE OF THE PRESENT HTP, THIS HTP MAY BE IMMEDIATELY CANCELLED. I ALSO UNDERTAKE THAT ANY ENTRY FORM FOR AN FIA INTERNATIONAL EVENT WILL BE FILLED IN ACCORDING TO THE INFORMATION GIVEN ON THE PRESENT FORM. Name of the Applicant: Name of the car owner (if different than the Applicant): Full address: Licence number (if applicable): Date: Signature: CAUTION: This document is intended solely to verify that, at the date of the inspection, the car appears to be eligible to compete in FIA-sanctioned events for Historic Vehicles (as defined in the International Sporting Code). It makes no representation as to the authenticity or history of the car. The ASN has not inspected the car for any purpose other than that specified above, and neither the ASN nor the FIA shall be held liable, in any way for the accuracy or fitness for a particular purpose (other than the purpose set forth above), of any information contained in this form. Such information has been supplied by the applicant on behalf of the owner of the car, who remains solely responsible for its accuracy. Name of the new car owner: Full address: CHANGE IN OWNERSHIP Licence number (if applicable): Name of the new car owner: Full address: Licence number (if applicable): Name of the new car owner: Full address: Licence number (if applicable):

Page25 16 ELIGIBILITY CHECKS If the car that is presented for an event is not in conformity with its HTP, refer to article 4.3 of Appendix K. THIS TABLE, TO BE FILLED IN ONLY BY FIA EVENT OFFICIALS AND ONLY WHEN NECESSARY, SERVES TO RECORD ANY COMMENTS MADE SUBSEQUENT TO SCRUTINEERING AT FIA INTERNATIONAL EVENTS. Date Venue Comments Name and status of the official

Page26 17 LOG BOOK THIS TABLE IS NOT COMPULSORY BUT MAY BE FILLED IN BY SCRUTINEERS (NOT FIA OFFICIALS ONLY) Date Venue Comments (e.g. heavy damage after crash or safety errors) Signature of the official

Page27 ONLY FOR SINGLE SEATER CARS, TWO-SEATER RACING CARS AND ANY OTHER CARS EQUIPPED WITH A ROLL OVER PROTECTION SYSTEM (ROPS) WHICH IS NOT HOMOLOGATED OR WHICH IS NOT CERTIFIED BY AN ASN TICK THE BOX (ONLY ONE) THAT APPLIES: I certify that the ROPS is as per period specification [Section 1.5 of page 23] I certify that the ROPS is as per Appendix K / self made system in compliance with Article 8 of Appendix VI to Appendix K [Section 1.4 of page 23] Or I certify that the ROPS is as per Appendix K / self made system in compliance with Article 8.1.1 of Appendix VI to Appendix K and that I have the relevant certificate substantiating the ROPS strength [Section 1.4 of page 23] As the issuing ASN is unable to control the following technical parameters without affecting the structural, historical and/or patrimonial integrity of the car (analysis of the material impossible without partial destruction or sampling of material), the issuing ASN relies on the Applicant s representations and the issuing ASN and/or the FIA shall not in any way be held responsible for any incorrect, inaccurate, false or misleading information provided herein by the Applicant. Wall thickness (mm) Material specifications Main/Lateral bar Front bar Diagonals Other struts Cross braces The items shown above are those claimed by the applicant based upon his best available knowledge. Applicant First Name: Applicant Last Name: Date: Name & Signature: