APPLICATION FOR A CERTIFICATE OF CONFORMITY/ DATING

APPLICATION FOR A
CERTIFICATE OF CONFORMITY/
DATING LETTER
Please fully complete the details below:
PART ‘A’ Which certificate do you require: (Please tick appropriate box)
 Certificate of Conformity
 Dating Certificate
 Both
PART ‘B’ (Application Details) *delete as appropriate
NAME:
Mr / Mrs / Miss*
ADDRESS:
ARE YOU THE ORIGINAL OWNER?
TELEPHONE NUMBER
EMAIL ADDRESS
 YES
 NO
Please appropriate box
PART ‘C’ (Vehicle Details)
MODEL:
VEHICLE IDENTIFICATION (CHASSIS) NO:
PLACE OF FIRST REGISTRATION:
DATE OF FIRST REGISTRATION:
Has the vehicle been altered, modified, written off or rebuilt
since leaving the original production factory:
If YES, please give details:
WORK CARRIED OUT
YES  NO 
Please appropriate box
CARRIED OUT BY
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DECLARATION
I understand that:
1) The duplicate Certificate of Conformity does not imply approval by MG Rover Group in Liquidation of the
standard of workmanship of any alteration to the vehicle’s original specification (including conversion of
steering hand).
2) MG Rover Group in Liquidation accepts no liability however arising in respect of the issue of the duplicate
Certificate of Conformity and/or Dating Certificate and therefore are unable to refund any monies paid.
3) MGR C&C Services accepts no liability however arising in respect of the issue of the duplicate Certificate
of Conformity and/or Dating Certificate and therefore are unable to refund any monies paid.
*
Please tick one Service Level and one Method of Payment (Note V.A.T. is not payable):
Chosen Delivery Service
Dating Certificate
Cert of Conformity
Dating Certificate
Cert of Conformity
 UK Standard Service
 UK Special Service
£100.00
£150.00
£100.00 + £7.50 (£107.50)
£150.00 + £7.50 (£157.50)
 Internat’l Std Service
 Internat’l “Sign For” Service
€127.00
€190.00
€127.00 + €13.00. (€140.00)
€190.00 + €13.00 (€203.00)
Note: No V.A.T. is payable
Method of Payment:
 Bank Card
 Postal Order
 Pay Pal
 Bankers Draft
 Bank transfer
 Cheque
Please send your payment, together with this application, as full and final payment for a
delivered Dating Certificate / Certificate of Conformity.
To:
MGR C & C Services Ltd
PO Box 13279
Stoke Heath
Bromsgrove
B60 9BS
Signature:
Date:
Name:
(BLOCK CAPITALS)