 
EN   EN 
 
 
 EUROPEAN  
COMMISSION   
Brussels, XXX   
[…](2024) XXX  draft  
ANNEXES 1 to 5  
 
ANNEXES  
to the  
Commission Implementing Regulation (EU) .../...  
laying down rules for the application of Regulation (EU) 2019/2144 of the European 
Parliament and of the Council as regards templates for the approval of the intelligent 
speed assistance system, the driver drowsiness and attention warning system, the event  
data recorder, the alcohol interlock installation facilitation and the advanced driver 
disctraction warning system                          
                                      
   
EN 1  EN ANNEX I  
 
PART 1  
Information document for EU type-approval  of motor  vehicles  with  regard  to their  
intelligent  speed  assistance  system  
 
Information document No … relating to the EU type -approval of a type of vehicle with regard 
to the intelligent speed assistance (ISA)  system.  
The following  information  shall  be supplied  in triplicate  and include  a list of contents.  Any 
drawings  or pictures  shall  be supplied  in appropriate  scale  and in sufficient  detail  on size A4 
or on a folder  of A4 format.  Photographs,  if any, shall  show  sufficient  detail.  
If the syste ms referred  to in this information  document  have  electronic  controls,  information  
concerning  their performance  shall  be supplied.  
0. GENERAL  
0.1. Make  (trade  name  of manufacturer):  
0.2. Type: 
0.2.1.  Commercial  name(s)  (if available):   
0.3. Means of identification  of type,  if marked  on the vehicle  / component  / separate  
technical  unit 1: 
0.3.1.  Location  of that marking:  
0.4. Category  of vehicle:  
0.5. Company  name  and address  of manufacturer:  
0.8. Name(s)  and address(es)  of assembly  plant(s):  
0.9. Name  and address  of the manufacturer’s  representative  (if any):  
1. GENERAL  CONSTRUCTION  CHARACTERISTICS  
1.1. Photograph s and/or  drawings  of a representative  vehicle/component/separate  
technical  unit 1: 
4.8. Speedometer  and odometer  
 Speedometer  
4.8.1.  Method of operation and description of drive mechanism:  
4.8.2.  Instrument constant:  
4.8.3.  Tolerance of the measuring mechanism pursuant to paragraph 2.2.3 of UN 
Regulation No 39 of the Economic Commission for Europe of the United 
Nations (UN/ECE)  2: 
4.8.4.  Overall transmission ratio pursuant to paragraph 2.2.2 of UN Regulation No 39 
or equivalent data:   
EN 2  EN 4.8.5.  Diagram of the speedometer scale or other forms of display:  
 Odometer  
4.8.6.  The technical constant of odometer pursuant to paragraph 2.2.4 of UN 
Regulation No 39:  
4.8.7.  The number of numerals:  
4.9. Tachograph: yes/no  1 
4.9.1.  Approval mark:  
4.10.  Differential lock: yes/no/optional1 
6.6. Tyres and wheels  
6.6.2.  Upper and lower limits of rolling radii  
6.6.2.1.  Axle 1: … mm  
6.6.2.2.  Axle 2: … mm  
6.6.2.3.  Axle 3: …mm  
6.6.2.4.  Axle 4: …mm  
6.6.3.  Tyre pressure(s) as recommended by the vehicle manufacturer: … kPa  
9.5. Windscreen  and other  windows  
9.5.1.  Wind screen  
9.5.1.1.  Materials  used:  
9.5.1.2.  Method of mounting:  
9.5.1.3.  Angle of inclination:  
9.5.1.4.  Number(s) of the type -approval certificate(s):  
9.5.1.5.  Windscreen accessories and the position in which they are fitted together with a 
brief description of any electrical/electronic components involved:  
12. MISCELLANEOUS  
12.6.  Speed  limitation  devices  
12.6.1.  Manufacturer(s):  
12.6.2.  Type(s):  
12.6.3.  Number(s) of the type -approval certificate (s), if available:  
12.6.4.  Speed or range of speeds at which the speed limitation may be set: …… km/h  
12.6.5. Intelligent  speed  assistance  (ISA)  system   
EN 3  EN 12.6.5. 2. Speed  limit  information  function  (SLIF):  
12.6.5. 2.1. Detailed  description  of the SLIF  interface:  
12.6.5. 2.2. Perceived  speed  limit  determination  methodology  and technology:  
12.6.5. 3. Speed  limit  warning  function  (SLWF):  
12.6.5. 3.1. Detailed  description  of the SLWF  feedback  mechanisms:  
12.6.5. 3.2. Detailed  description  of the SLWF  visual  warning,  if applicable:  
12.6.5. 4. Detailed  description  of the speed  control  function  (SCF):  
12.6.5. 5. Type -approval  number  of the ISA system  as separate  technical  unit, if 
applicable:  
  
___________________  
1 Delete where not applicable.  
2 UN Regulation No 39 of the Economic Commission for Europe of the United Nations (UN/ECE) – 
Uniform provisions conce rning the approval of vehicles with regard to the speedometer and odometer 
equipment including its installation (OJ L 302 28.11.2018, p. 106 , ELI: 
http://data.europa.eu/eli/reg/2018/1857/oj ). 
   
EN 4  EN PART II 
 
EU TYPE -APPROVAL CERTIFICATE (VEHICLE SYSTEM)  
 
Communication  concerning  granting  / extension  / refusal  / withdrawal  1 of type-approval  of a 
type of vehicle  with regard  to its intelligent  speed  assistance  (ISA)  system  in accordance with 
the requirements  laid down  in Commission  Delegated  Regulation  (EU)  2021 /1958  2, as last 
amended  by Regulation  (EU)  No …/…  
Number  of the EU type-approval  certificate:   
Reason  for extension  / refusal  / withdrawal  1:  
 
SECTION I  
0.1. Make (trade name of manufacturer):  
0.2. Type:  
0.2.1.  Commercial name(s) (if available):  
0.3. Means of identification of type, if marked on the vehicle:  
0.3.1.  Location of that marking:  
0.4. Category of vehicle:  
0.5. Name and address of manufacturer:  
0.8. Name(s) and address(es) of assembly plant(s):  
0.9. Name and address of the manufacturer's representative (if any):  
 
SECTION II  
1. Additional information (where applicable): se e Addendum.  
2. Technical service responsible for carrying out the tests:  
3. Date of test report:  
4. Number of test report:  
5. Remarks (if any): see Addendum.  
6. Place:  
7. Date:  
8. Signature:  
___________________   
EN 5  EN 1 Delete where not applicable.  
2 Commission  Delegated  Regulation  (EU)  2021/1958  of 23 June 2021  supplementing  Regulation  (EU)  
2019/2144  of the European  Parliament  and of the Council  by laying  down  detailed  rules  concerning  the specific  
test procedures  and technical  requirements  for the type-approval  of motor  vehicles  with regard  to their intelligent  
speed  assistance  systems  and for the type-approval  of those  systems  as separate  technical  units  and amending  
Annex  II to that Regulation  (OJ L409, 17.11.2021, p. 1 , ELI: http://data.europa.eu/eli/reg_del/2021/1958/oj ). 
 
Addendum  
to EU  type-approval certificate number   
1. Additional  information  
1.1. Description  of the system  
1.2. Speed  limit information  function  (SLIF):  
1.2.1. Description  of the SLIF  interface:  
1.2.2. Perceived  speed  limit  determination  methodology  and technology:  
1.3. Speed  limit  warning  function  (SLWF):  
1.3.1 Detailed  description  of the SLWF  feedback  mechanisms:  
1.3.2. Detailed  description  of the SLWF  visual  warning,  if applicable:  
1.4. Detailed  description  of the speed  control  function  (SCF):  
1.5. Type -approval  number  of the ISA system  as separate  technical  unit, if applicable:  
 
PART III  
EU TYPE -APPROVAL CERTIFICATE (S EPARATE TECHNICAL UNIT) 
 
Communication  concerning  granting  / extension  / refusal  / withdrawal  1 of type-approval  of a 
type of an intelligent  speed  assistance  (ISA)  system  in acco rdance with the requirements  laid 
down  in Commission  Delegated  Regulation  (EU)  2021 /1958  2, as last amended  by Regulation  
(EU)  No …/…  
Number  of the EU type-approval  certificate:   
Reason  for extension  / refusal  / withdrawal  1:  
 
SECTION I  
0.1. Make (trade name of manufacturer):  
0.2. Type:  
0.2.1.  Commercial name(s) (if available):  
0.3. Means of identification of type, if marked on the vehicle:   
EN 6  EN 0.3.1.  Location of that marking:  
0.4. Category of vehicle:  
0.5. Name and address of manufacturer:  
0.8. Name(s) and address(es) of assembly plant(s):  
0.9. Name and address of the manufacturer's representative (if any):  
 
SECTION II  
1. Additional information (where applicable): see Addendum.  
2. Technical service responsible for carrying out the tests:  
3. Date of test report:  
4. Number of test report:  
5. Remarks (if any): see Addendum.  
6. Place:  
7. Date:  
8. Signature:  
___________________  
1 Delete where not applicable.  
2 Commission Delegated Regulation (EU) 2021/1958 of 23 June 2021 supplementing Regulation (EU) 
2019/2144 o f the European Parliament and of the Council by laying down detailed rules concerning the specific 
test procedures and technical requirements for the type -approval of motor vehicles with regard to their intelligent 
speed assistance systems and for the type -approval of those systems as separate technical units and amending 
Annex II to that Regulation (OJ L409, 17.11.2021, p. 1, ELI: http://data.europa.eu/eli/reg_del/2021/1958/oj).  
 
Addendum  
to EU type -approval certificate number  
1. Brief description of the type of separate technical unit:  
1.1. Speed  limit  information  function  (SLIF):  
1.1.1.  Description  of the SLIF  interface:  
1.1.2.  Perceived  speed  limit  determination  methodology  and technology:  
1.2. Speed  limit  warning  function  (SLWF):   
EN 7  EN 1.2.1.  Detailed  description  of the SLWF  feedback  mechanisms:  
1.2.2.  Detailed  description  of the SLWF  visual  warning,  if applicable:  
1.3. Detailed  description  of the speed  control  function  (SCF):  
2. Separate technical unit: semi -universal/vehicle specific1 
3. List of specific vehicle types for which the separate technical unit has been approved (if 
applicable):  
4. Installation requirements : 
5. Remarks:  
6. Type -approval mark and its location:  
  
EN 8  EN ANNEX II  
 
PART I 
Information document for EU type-approval  of vehicles  with  regard  to their  driver  
drowsiness  and attention  warning  system  
 
Information document No … relating to the EU type -approval of a type of vehicle with regard 
to the driver drowsiness and  attention warning (DDAW)  system.  
The following  information  shall  be supplied  in triplicate  and include  a list of contents.  Any 
drawings  or pictures  shall  be supplie d in appropriate  scale  and in sufficient  detail  on size A4 
or on a folder  of A4 format.  Photographs,  if any, shall  show  sufficient  detail.  
If the systems,  referred  to in this information  document  have  electronic  controls,  information  
concerning  their performance  shall be supplied.  
0. GENERAL  
0.1. Make (trade  name  of manufacturer):  
0.2. Type:  
0.2.1.  Commercial  name(s)  (if available):   
0.3. Means  of identification  of type,  if marked  on the vehicle  / component  / separate  
technical  unit 1: 
0.3.1.  Location  of that marking:  
0.4. Category  of vehicle:  
0.5. Company  name  and address  of manufacturer:  
0.8. Name(s)  and address(es)  of assembly  plant(s):  
0.9. Name and address  of the manufacturer’s  representative  (if any):  
12.11. Driver  drowsiness  and attention  warning  (DDAW)  system  
12.11. 2. Detailed  descriptio n of the DDAW  system:  
12.11. 3. Detailed  description  of the visual  warning  of the DDAW  system:  
12.11. 3.1. Reference  of the code  of the test protocol  tested  by the Technical  Service,  for 
which  the DDAW  system  shall  deliver  a warning  when  performed:  
12.11. 4. Detail  description  of the technical  similarities  of the adaptation  required  to 
enable  the DDAW  system:  
___________  
1 Delete  where  not applicable.   
   
EN 9  EN PART II 
EU TYPE -APPROVAL CERTIFICATE (VEHICLE SYSTEM)  
 
Communication  concerning  granting  / extension  / refusal  / withdrawal  1 of type-approval  of a 
type of vehicle  with regard  to its driver  drow siness  and attention  warning  (DDAW)  system  in 
accordance with the requirements  laid down  in Commission  Delegated  Regulation  (EU)  
2021 /1341 2, as last amended  by Regulation  (EU)  No …/…  
Number  of the EU type-approval  certificate:   
Reason  for extension  / refusal  / withdr awal  1:  
 
SECTION I  
0.1. Make (trade name of manufacturer):  
0.2. Type:  
0.2.1.  Commercial name(s) (if available):  
0.3. Means of identification of type, if marked on the vehicle:  
0.3.1.  Location of that marking:  
0.4. Category of vehicle:  
0.5. Name and address of manufacturer:  
0.8. Name(s) and address(es) of assembly plant(s):  
0.9. Name and address of the manufacturer's representative (if any):  
 
SECTION II  
1. Additional information (where applicable): se e Addendum.  
2. Technical service responsible for carrying out the tests:  
3. Date of test report:  
4. Number of test report:  
5. Remarks (if any): see Addendum.  
6. Place:  
7. Date:  
8. Signature:  
___________________  
1 Delete where not applicable.   
EN 10  EN 2 Commission Delegated Regulation (EU) 2021/1 341 of 23 April  2021 supplementing Regulation (EU) 
2019/2144 of the European Parliament and of the Council by laying down detailed rules concerning the specific 
test procedures and technical requirements for the type -approval of motor  vehicles with regard to their driver 
drowsiness and attention warning systems and amending Annex II to that Regulation (OJ L 292, 16.8.2021, p. 4, 
ELI: http://data.europa.eu/eli/reg_del/2021/13 41/oj ). 
 
Addendum  
to EU  type-approval certificate number   
1. Additional  information  
1.1. Description  of the system : 
3. Remark s: 
   
EN 11  EN ANNEX II I 
 
PART I 
Information document for EU type-approval  of vehicles  with  regard  to their  event  data  
recorder  
 
Information document No … relating to the EU type -approval of a type of vehicle with regard 
to its event data recorder (EDR) . 
The following  information  shall  be supplied  in triplicate  and include  a list of contents.  Any 
drawings  or pictures  shall  be supplied  in appropriate  scale  and in sufficient  detail  on size A4 
or on a folder  of A4 format.  Photographs,  if any, shall  show  sufficient  detail.  
If the systems,  referred  to in this information  document  have  electronic  controls,  information  
concerning  their performance  shall  be supplied.  
0. GENERAL  
0.1. Make  (trade  name  of manufacturer):  
0.2. Type: 
0.2.1.  Commercial  name(s)  (if available):   
0.3. Means of identification  of type,  if marked  on the vehicle  / component  / separate  
technical  unit 1: 
0.3.1.  Location  of that marking:  
0.4. Category  of vehicle:  
0.5. Company  name  and address  of manufacturer:  
0.8. Name(s)  and address(es)  of assembly  plant(s):  
0.9. Name  and address  of the manufacturer’s  representative  (if any):  
1. GENERAL  CONSTRUCTION  CHARACTERISTICS  
1.1. Photographs  and/or  drawings  of a representative  vehicle  / component  / separate  
technical  unit 1: 
12.16.  Event data recorder (EDR)  
12.16.2.  Drawing(s)  or photographs  showing  the location  and method  of attachment  of 
the EDR  in the vehicle:  
12.16.3.  Description  of the triggering  parameter:  
12.16.4.  Description  of any other  relevant  parameter  (storing  capacity,  resistance  to high 
decele ration  and mechanical  stress  of a severe  impact,  etc.):  
12.16.5.  The data elements  and data format  stored  in the EDR:  
 Data  Recording Data sample rate  Minimum Accuracy  Resolution   
EN 12  EN element  interval/time  
(relative to time 
zero)  (samples per 
second)  range  
            
            
            
 
12.16.6.  Instructions  for retrieving  data from  the EDR:  
12.16.6.1.  Description  of the method  to report  information  required  under  Article  4(3), 
point  (b), of Commission  Delegated  Regulation  (EU)  2022/545  2: manual  / 
automat ed 1 
12.16.7.  Compli ance to UN Regulation No 160  3 technical requirements:  
12.16.7.1.  UN Regulation No 160 approval number:  
12.16. 8. Type -approval  number  of the EDR  approved  as separate  technical  unit, if 
applicable  (to be completed  if approval  under  UN Regulation  No 160 is not 
obtained  and referred  to in point  12.16. 7.1.): 
___________________  
1 Delete where not applicable.  
2 Commission Delegated Regulation (EU) 2022/545 of 26 January 2022 supplementing Regulation (EU) 
2019/2144 of the European Parliament and of the Council by laying down detailed rules concerning the specific 
test procedures and technical req uirements for the type -approval of motor vehicles with regard to their event data 
recorder and for the type -approval of those systems as separate technical units and amending Annex II to that 
Regulation (OJ L 107, 6.4.2022, p. 18, ELI: http://data.europa.eu/eli/reg_del/2022/545/oj ). 
3 UN Regulation No  160 – Uniform provisions concerning the approval of motor vehicles with regard to 
the Event Data Recorder [2021/1215] 01 series of amendments ( OJ L 265, 26.7.2021, p. 3 , ELI:  
http://data.europa.eu/eli/reg/2021/1215/oj ). 
   
EN 13  EN PART 2 
 
EU TYPE -APPROVAL CERTIFICATE (VEHICLE SYSTEM)  
 
Communication  concerning  granting  / extension  / refusal  / withdrawal  1 of type-approval  of a 
type of vehicle  with regard  to its event  data recorder  (EDR)  in accordance with the 
requirements  laid down  in Commission  Delegated  Regulation  (EU)  2022/545 2, as last 
amended  by Regulation  (EU)  No …/…  
Number  of the EU type-approval  certificate:   
Reason  for extension  / refusal  / withdrawal  1:  
 
SECTION I  
0.1. Make (trade name of manufacturer):  
0.2. Type:  
0.2.1.  Commercial name(s) (if available):  
0.3. Means of identification of type, if marked on the vehicle:  
0.3.1.  Location of that marking:  
0.4. Category of vehicle:  
0.5. Name and address of manufacturer:  
0.8. Name(s) and address(es) of assembly plant(s):  
0.9. Name and address of the manufacturer's representative (if any):  
 
SECTION II  
1. Additional information (where applicable): se e Addendum.  
2. Technical service responsible for carrying out the tests:  
3. Date of test report:  
4. Number of test report:  
5. Remarks (if any): see Addendum.  
6. Place:  
7. Date:  
8. Signature:  
___________________   
EN 14  EN 1 Delete where not applicable.  
2 Commission Delegated Regulation (EU) 2022/545 of 26 January 2022 supplementing Regulation (EU) 
2019/2144 of the European Parliament and of the Council by laying down detailed rules concerning the specific 
test procedures and technical requirements for the type -approval of moto r vehicles with regard to their event data 
recorder and for the type -approval of those systems as separate technical units and amending Annex II to that 
Regulation (OJ L 107, 6.4.2022, p. 18, ELI: http://data.europa.eu/eli/reg_del/2022/545/oj).  
 
 
Addendum  
to EU  type-approval certificate number   
1. Additional  information  
1.1. Description  of the system  
1.2. Description  of the method  to report  information  required  under  Article  4(3), point  (b), of 
Commission  Delegated  Regulation  (EU)  2022/ 545: 
2. UN Regulation  No 160 approval  number:  
3. Remark s 
   
EN 15  EN PART  III 
 
EU TYPE -APPROVAL CERTIFICATE ( SEPARATE TECHNICAL UNIT ) 
 
Communication  concerning  granting  / extension  / refusal  / withdrawal  1 of type-approval  of a 
type of event  data recorder  (EDR)  as a separate  unit in accordance with the requirements  laid 
down  in Commission  Delegated  Regulation  (EU)  2022/545 2, as last amended  by Regulation  
(EU)  No …/…  
Number  of the EU type-approval  certificate:   
Reason  for extension  / refusal  / withdrawal  1:  
 
SECTION I  
0.1. Make (trade name of manufacturer):  
0.2. Type:  
0.2.1.  Commercial name(s) (if available):  
0.3. Means of identification of type, if marked on the vehicle:  
0.3.1.  Location of that marking:  
0.4. Category of vehicle:  
0.5. Name and address of manufacturer:  
0.8. Name(s) and address(es) of assembly plant(s):  
0.9. Name and address of the manufacturer's representative (if any):  
 
SECTION II  
1. Additional information (where applicable): se e Addendum.  
2. Technical service responsible for carrying out the tests:  
3. Date of test report:  
4. Number of test report:  
5. Remarks (if any): see Addendum.  
6. Place:  
7. Date:  
8. Signature:  
___________________   
EN 16  EN 1 Delete where not applicable.  
2 Commission Delegated Regulation (EU) 2022/545 of 26 January 2022 supplementing Regulation (EU) 
2019/2144 of the European Parliament and of the Council by laying down detailed rules concerning the specific 
test procedures and technical requirements for the type -approval of moto r vehicles with regard to their event data 
recorder and for the type -approval of those systems as separate technical units and amending Annex II to that 
Regulation (OJ L 107, 6.4.2022, p. 18, ELI: http://data.europa.eu/eli/reg_del/2022/545/oj).  
 
 
Addendum  
to EU  type-approval certificate number   
1. Additional  information  
1.1. Description  of the system  
1.2. Description  of the method  to report  information  required  under  Article  4(3), point  (b), of 
Commission  Delegated  Regulation  (EU)  2022/ 545: 
2. UN Regulation  No 160 approval  number:  
3. Remark s  
EN 17  EN ANNEX I V 
 
PART I 
Information document for EU type-approval  of vehicles  with  regard  to the alcohol  
interlock  installation  facilitation  
 
Information document No … relating to the EU type -approval of a type of vehicle with regard 
to the alcohol interlock installation facilitation . 
The following  information  shall  be supplied  in triplicate  and include  a list of contents.  Any 
drawings  or pictures  shall  be supplied  in appropriate  scale  and in sufficient  detail  on size A4 
or on a folder  of A4 format.  Photographs,  if any, shall  show  sufficient  detail.  
 
0. GENERAL  
0.1. Make (trade  name  of manufacturer):  
0.2. Type:  
0.2.1.  Commercial  name(s)  (if available):   
0.3. Means  of identification  of type,  if marked  on the vehicle  / component  / separate  
technical  unit 1: 
0.3.1.  Location  of that marking:  
0.4. Category  of vehicle:  
0.5. Company  name  and address  of manufacturer:  
0.8. Name(s)  and address(es)  of assembly  plant(s):  
0.9. Name and address  of the manufacturer’s  representative  (if any):  
12.2.4 . Alcohol  interlock  installation  facilitation  (AIF)  
12.2.4. 1. Manufacturer’s declaration  of compliance  in accordance with Annex I to 
Commission Delegated Regulation (EU) 2021/ 1243  2: 
12.2.4.2.  Installation document as regards the alcohol interlock installation facilitation  
_____ ______________  
1 Delete where not applicable . 
2 Commission Delegated Regulation (EU) 2021/1243 of 19 April 2021 supplementing Regulation (EU) 
2019/2144 of the European Parliament and of the Council by laying down detailed rules concerning the alcohol 
interlock installation facilitation in motor vehicles and amending Annex II to that Regulation  (OJ L272, 
30.7.2021, p. 11 , ELI: http://data.europa.eu/eli/reg_del/2021/1243/oj ). 
   
EN 18  EN PART II 
 
EU TYPE -APPROVAL CERTIFICATE (VEHICLE SYSTEM)  
 
Communication  concerning  granting  / extension  / refusal  / withdrawal  1 of type-approval  of a 
type of vehicle  with regard  to the alcohol  interlock  installation  facilitation  in accordance with 
the requirements  laid down  in Commission  Delegated  Regulation  (EU)  2021 /1243 2, as last 
amended  by Regulation  (EU)  No …/…  
Number  of the EU type-approval  certificate:   
Reason  for extension  / refusal  / withdrawal  1:  
 
SECTION I  
0.1. Make (trade name of manufacturer):  
0.2. Type:  
0.2.1.  Commercial name(s) (if available):  
0.3. Means of identification of type, if marked on the vehicle:  
0.3.1.  Location of that marking:  
0.4. Category of vehicle:  
0.5. Name and address of manufacturer:  
0.8. Name(s) and address(es) of assembly plant(s):  
0.9. Name and address of the manufacturer's representative (if any):  
 
SECTION II  
1. Additional information (where applicable): se e Addendum.  
2. Technical service responsible for carrying out the tests:  
3. Date of the report:  
4. Number of the report:  
5. Remarks (if any): see Addendum.  
6. Place:  
7. Date:  
8. Signature:  
___________________   
EN 19  EN 1 Delete where not applicable.  
2 Commission Delegated Re gulation (EU) 2021/1243 of 19 April 2021 supplementing Regulation (EU) 
2019/2144 of the European Parliament and of the Council by laying down detailed rules concerning the alcohol 
interlock installation facilitation in motor vehicles and amending Annex II to that Regulation  (OJ L272, 
30.7.2021, p. 11, ELI: http://data.europa.eu/eli/reg_del/2021/1243/oj ). 
 
 
Addendum  
to EU  type-approval certificate number   
1. Additional  information  
1.1. Description  of the alcohol  interlock  installation  facilitation : 
1.2. Manufacturer’s declaration:  
1.3. Installation document:  
3. Remark s: 
  
ANNEX V  
 
PART I 
Information document for EU type-approval  of vehicles  with  regard  to their  advanced  
driver  distraction  warning  system  
 
Information document No … relating to the EU type -approval of a type of vehicle with regard 
to the advanced driver distraction warning (ADDW)  system.  
The following  information  shall  be supplied  in triplicate  and include  a list of contents.  Any 
drawings  or pictures  shall  be supplied  in appropriate  scale  and in sufficient  detail  on size A4 
or on a folder  of A4 format.  Photographs,  if any, shall  show  sufficient  detail.  
If the systems  referred  to in this information  document  have  electronic  controls,  information  
concerning  their performance  shall  be supplied.  
0. GENERAL  
0.1. Make (trade  name  of manufacturer):  
0.2. Type:  
0.2.1.  Commercial  name(s)  (if available):   
0.3. Means  of identification  of type,  if marked  on the vehicle  / component  / separate  
technical  unit 1: 
0.3.1.  Location  of that marking:  
0.4. Category  of vehicle:   
EN 20  EN 0.5. Company  name  and address  of manufacturer:  
0.8. Name(s)  and address(es)  of assembly  plant(s):  
0.9. Name and address  of the manufacturer’s  representative  (if any):  
12.12. Advanced  driver  distraction  warning  (ADDW)  system  
12.12.1. Presence:  yes/no1 
12.12.2. Detailed  description  of the ADDW  system:   
12.12.3. Detailed  description  of the technical  means  of distraction  avoidance,  if 
applicable:   
   
EN 21  EN PART II 
EU TYPE -APPROVAL CERTIFICATE (VEHICLE SYSTEM)  
 
Communication  concerning  granting  / extension  / refusal  / withdrawal  1 of type-approval  of a 
type of vehicle  with regard  to its advanced  driver  distraction  warning  (ADDW ) system  in 
accordance with the requirements  laid down  in Commission  Delegated  Regulation  (EU)  
2023/2590  2, as last amended  by Regulation  (EU)  No …/…  
Number  of the EU type-approval  certificate:   
Reason  for extension  / refusal  / withdr awal  1:  
 
SECTION I  
0.1. Make (trade name of manufacturer):  
0.2. Type:  
0.2.1.  Commercial name(s) (if available):  
0.3. Means of identification of type, if marked on the vehicle:  
0.3.1.  Location of that marking:  
0.4. Category of vehicle:  
0.5. Name and address of manufacturer:  
0.8. Name(s) and address(es) of assembly plant(s):  
0.9. Name and address of the manufacturer's representative (if any):  
 
SECTION II  
1. Additional information (where applicable): se e Addendum.  
2. Technical service responsible for carrying out the tests:  
3. Date of test report:  
4. Number of test report:  
5. Remarks (if any): see Addendum.  
6. Place:  
7. Date:  
8. Signature:  
___________________  
1 Delete where not applicable.   
EN 22  EN 2 Commission Delegated Regulation (EU) 2023/2590 of 13 July 2023 supplementing Regulation (EU) 
2019/2144 of the European Parliament and of the Council by laying down detailed rules concerning the specific 
test procedures and technical requirements for the type -approval of certai n motor vehicles with regard to their 
advanced driver distraction warning systems and amending that Regulation  (OJ L, 2023/2590, 22.11.2023, ELI: 
http://data.europa.eu/eli/reg_del/2023/2590/oj ). 
 
Addendum  
to EU  type-approval certificate number   
1. Addi tional  information  
1.1. Description  of the system : 
  
3. Remark s: 
  
 