Low Emission Zone Vehicle Registration Form Use this form if your vehicle is affected by the Low Emission Zone (LEZ) and Transport for London (TfL) does not have all the relevant details of your vehicle on their database. TfL hold records for most GB registered vehicles. You can check the information held by TfL using the compliance check at tfl.gov.uk/lezlondon or by calling 0845 607 0009. Areas in bold are compulsory fields and must be completed. Sections 1, 2 and 4 are compulsory. A photocopy of the vehicle registration document must be supplied with the form otherwise your application will be rejected. Please complete in BLACK ink. Please read the guidance notes before completing this form so that you provide the right information for the vehicle. Section 1 - About You Title (Mr, Mrs, Miss, Ms) First Name Middle Initial(s) Last Name Organisation Name Address Post Code/Zip Country Daytime Telephone No Evening Telephone No Mobile Telephone No Email Address How would you prefer us to contact you? By Email By Post Tick Please tick this box if you are happy for us to contact you to take part in a customer satisfaction survey. LEZ_REG v1.0
Section 2 - About The Vehicle Please tick ONE of the following boxes to indicate the type of vehicle being registered and fill in the relevant information. Heavier Lorries Goods vehicles exceeding 12 tonnes Lighter Lorries Goods vehicles between 3.5 and 12 tonnes Buses and Coaches Passenger Vehicles with more than 8 seats plus the drivers seat exceeding 5 tonnes Large Vans Goods vehicles between 1.205 tonnes (unladen) and 3.5 tonnes Minibuses Passenger Vehicles with more than 8 seats plus the drivers seat below 5 tonnes Number of seats (incl. driver) Unladen Weight Number of seats (incl. driver) N.B. The vehicle weight is a good guide as to when your vehicle will be affected by the LEZ. If your type of vehicle does not appear here you should use the weight limits used for lorries and large vans set out in the guidance notes as a guide and/or contact your vehicle manufacturer or Transport for London (TfL) for guidance. Please complete the following details which can be found on the vehicle registration document (V5C) Country Issuing The Registration Certificate Vehicle Registration Mark (Number Plate) Date of First Registration Vehicle Identification Number (VIN)/Chassis Number/ Frame Number Make Model Year of Manufacture y y y y Fuel Type (Please tick only one of the following) Diesel (heavy oil, bio diesel) Electric Diesel (hybrid) Other (please specify) Gas Diesel (dual fuel) Gas (spark ignition)
Original Euro standard as shown on your vehicle registration document Euro I/1 Euro II/2 Euro III/3 Euro IV/4 Euro V/5 Section 3 - Next Steps Please tick all that apply This is a Showman s vehicle which is custom built and permanently fitted with equipment forming part of the show. I am enclosing at least four photographs as specified in the guidance notes. Go to Section 4 This vehicle is not registered in Great Britain and was constructed before 1 January 1973. Go to Section 4 A pollution abatement device has been fitted to this vehicle. Go to Section 3.1 The engine has been replaced or was manufactured to meet Euro III/3 emmisions standards or better, prior to October 2001. Go to Section 3.2 The vehicle has been converted to run on gas. Go to section 3.3 None of the above applies to this vehicle. Go to Section 4 Section 3.1 - Pollution Abatement Equipment Use this section if a pollution abatement device has been fitted to the vehicle. Pollution Abatement Device Manufacturer Pollution Abatement Device Type Please state the vehicle s particulate levels following fitment of the pollution abatement device. Please complete only one of the following: 1. Vehicle Euro Standard Euro I/1 Euro II/2 Euro III/3 Euro IV/4 Euro V/5 or 2. Particulate Matter Emissions g/km or g/kwh or 3. Particulate Matter % reduction Please confirm by ticking the box below that a photocopy of the following has been provided. NOTE - Please do not send originals as these will not be returned. Inspection Certificate Certifying Authority
Section 3.2 - Engine Details Use this section if the vehicle: Was registered as new prior to 1 October 2001 but has an engine that achieves Euro III/3 emissions standards or better. Has had a new or replacement engine fitted. Engine make (manufacturer) Engine type (model) Please state the engine s particulate levels. Please complete only one of the following: 1. Engine Euro Standard Euro I/1 Euro II/2 Euro III/3 Euro IV/4 Euro V/5 or 2. Particulate Matter Emissions (as per Engine Type Approval Certificate or Inspection Certificate) g/km or g/kwh Please confirm by ticking the box(es) that a photocopy of one of the following has been provided. NOTE - Please do not send originals as these will not be returned. Vehicle Type Approval Certificate (from the vehicle manufacturer) Engine Type Approval Certificate (from the engine manufacturer) Certificate of Fitting Issuing Authority Inspection Certificate Certifying Authority
Section 3.3 - Fuel Conversion Use this section if the vehicle has been converted to run on gas. Fuel Conversion Kit Manufacturer Fuel Conversion Kit Type Please state the fuel type that the engine now uses Gas (spark ignition) Other (please specify) Please confirm by ticking the box that a photocopy of one of the following has been provided. NOTE - Please do not send originals as these will not be returned. Certificate of Fitting Issuing Authority Inspection Certificate Certifying Authority Checklist Before sending this to us, please check that you have completed the following: Section 1 Section 2 Photocopied vehicle registration document supplied Section 4 signed and dated If any part of section 3 has been completed, photocopies of evidence to support: Eligibility for a 100% discount for a Showman s vehicle Photocopied proof that a pollution abatement device has been fitted Photocopied proof of the engine details Photocopied proof of a gas conversion Please only send photocopies of documents - originals will not be returned.
Section 4 - Declaration Please read the following declaration very carefully and sign where indicated to confirm that you have read and understood it. If you do not sign and date this declaration then your application will be rejected. By signing this form, I certify that I fully understand the criteria for registering a vehicle affected by the London Low Emission Zone (LEZ) with Transport for London (TfL) as set out in the guidance notes. The details given on this form are to the best of my knowledge true and correct and I understand that filing a false declaration knowingly and wilfully is a criminal offence for which I may be prosecuted. In accordance with the requirements of the LEZ Scheme Order I undertake to notify TfL of any change in circumstances that may affect the validity of the vehicle to travel in the LEZ without paying the daily charge. By signing this form, I confirm that I am aware of the data protection information provided in the guidance notes to this form. Where TfL requires verification from a third party (relevant third parties are listed in the guidance notes), I request that the appropriate third party provide TfL with the information required to verify that the information I have supplied on this form is correct. I understand that TfL needs to identify possible fraudulent statements of emissions standards and use of the discount. I accept that this may include on-street checks and the analysis of the movements of randomly selected vehicles in the LEZ. I agree that if I have applied for a discount or exemption to which the vehicle is not entitled, TfL may disclose relevant details to Law Enforcement agencies. I understand that TfL may share data provided in the form with other Local Authorities and the Police for the prevention and detection of crimes and the protection of public funds. I understand that the vehicle details included in this application will not be updated on TfL s register until I have received written confirmation from TfL of the outcome of this application. If the vehicle travels within the LEZ before the vehicle registration is approved, and the daily charge is not paid, I understand that the registered keeper may be liable to pay a Penalty Charge. I understand and accept that Authorised Officers working on behalf of TfL may ask to inspect the vehicle before or after issue of a compliant or discount status or exemption to confirm I have given correct information. If this consent is not given, TfL may not issue the vehicle with a compliant or discount status or exemption or the compliant or discount status or exemption may be withdrawn. Signature Date Marketing Notice Transport for London (TfL) would like to update you on its transport related products including the Low Emission Zone and other transport related issues. Updates may reflect the TfL products and services you have used before and may be by mail, e-mail or telephone. TfL will not disclose your details to third parties for marketing purposes. If you would like to receive these updates, please tick this box