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APPLICATION TO RESERVE A VEHICLE REGISTRATION NUMBER Form VRT 15A APPLICANT DETAILS the owner of the vehicle only Name Address Telephone No Email Tax Number PPSN/VAT/TAN I wish to reserve the following Registration Number for assignment to a vehicle owned by the above named applicant District Year Half Number Cheque Bank Draft tick as appropriate for 1 000. Postal Order I enclose a I understand that a reserved registration number can only be assigned to a vehicle when it has been reached in the normal sequence and that it may not be displayed on a vehicle before it has been formally assigned by Revenue following the presentation and acceptance of a completed declaration for registration* the normal course. I agree to the conditions listed below. Half 1 if vehicle will come in to use between 1 Jan 30 June 2 if between 1 July 31 Dec Signature Date D D M M Y Y Name Block Letters Company Position If signing on behalf of a company Please note the following conditions The applicant name must be that of the person or the legally accountable entity by whom the vehicle will be kept. A trading name which is not the name of a legally accountable entity is not acceptable. Applications will only be accepted from 1 November of the preceding year. Numbers can only be used in the relevant calendar year. The registration number must correspond with the place licensing authority area at which the applicant at the time of registration will be ordinarily resident. This should correspond with the address linked to the tax number of the applicant. Reserved Registration Numbers are not transferable. Applicants should note that the fee in the event that the reservation is no longer required will be refundable only in exceptional circumstances and only on foot of a request for cancellation by the applicant named above together with the original notification letter. The fee of 1 000 cheque/bank-draft/postal-order made payable to the Collector Customs and Excise should be enclosed with this form* Further information on how to reserve a registration number is available at http //www. revenue. ie/en/tax/vrt/ leaflets/reserve-reg-number. html* The completed application should be sent to The Central Vehicle Office Revenue Commissioners Rosslare Harbour Co. Wexford. FOR CENTRAL VEHICLE OFFICE USE ONLY Application has been recorded in - ITP D/B Notice of reservation has been issued Receipt Number has been issued* RPC003770ENWBL1 Yes October 2013. Postal Order I enclose a I understand that a reserved registration number can only be assigned to a vehicle when it has been reached in the normal sequence and that it may not be displayed on a vehicle before it has been formally assigned by Revenue following the presentation and acceptance of a completed declaration for registration* the normal course. I agree to the conditions listed below. Half 1 if vehicle will come in to use between 1 Jan 30 June 2 if between 1 July 31 Dec Signature Date D D M M Y Y Name Block Letters Company Position If signing on behalf of a company Please note the following conditions The applicant name must be that of the person or the legally accountable entity by whom the vehicle will be kept.

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