Part
592.6(l)
Notification
of
Business
Change
OMB No. 2127-0002
Exp. 04-30-2017
National Highway Traffic Safety Administration
Import and Certification Division Phone: (202) 366-0115
Website Address: www.nhtsa.dot.gov/cars/rules/import/
NHTSA Form 1483
Use this form to submit the RI's Notification of Business Change to notify NHTSA of relevant changes to the RI business that occurred after the last Yearly Statement was submitted or after the initial application for registration as an importer.
Applicant Name:
Last First
Middle
Position:
Business Address: City:
Country
Form of Business Organization:
State under which business formed:
Name
Last First Middle
Date of Birth
Position
Owned %
Business Address
Street, Suite No.
City State/Province
Zip Code
Name
Last First Middle
Date of Birth
Position Owned %
Business Address
Street, Suite No.
City State/Province
Zip Code
Name
Last First Middle
Date of Birth
Position
Owned %
Business Address
Street, Suite No.
City State/Province
Zip Code
(Attach
a separate
page if
there are
more than
3
partners/officers/directors/managers)
I am willing to contract with individual owners to conform to the safety and bumper standards the following types of vehicles those owners import, provided the vehicles have been determined to be eligible for importation pursuant to 49 CFR Part 593 (check all that apply): |
|||||||
Passenger Cars |
MPVs |
Light Duty Trucks (10,000 lb GVWR or less) |
Trailers |
Buses |
|||
Heavy Trucks & Tractors (Over 10,000 lb GVWR) |
Motorcycles / Motor Driven Cycles |
Low-speed Vehicles |
|
Business Address City
State
Country
Zip Code
Telephone Number Fax Number
Date Facility First Used
Date Facility Closed
Same
as Main
Office
Business Address City
State
Country
Zip Code
Telephone Number Fax Number
Date Facility First Used
Date Facility Closed
Same
as Main
Office
Business Address City
State
Country
Zip Code
Telephone Number Fax Number
Date Facility First Used
Date Facility Closed
Same
as Main
Office
Business Address City
State
Country
Zip Code
Telephone Number Fax Number
Date Facility First Used
Date Facility Closed
Principal Name (Last, First and Middle) Title
Principal Name (Last, First and Middle)
Title
Principal Name (Last, First and Middle)
Title
Principal Name (Last, First and Middle)
Title
* Principal, with respect to a Registered Importer, means any officer of a corporation, a general partner of a partnership, or the sole proprietor of a sole proprietorship. The term includes a director of an incorporated Registered Importer, and any person whose ownership interest in a Registered Importer is 10% or more.
Principal Name (Last, First and Middle)
Title
Principal Name (Last, First and Middle) Title
Principal Name (Last, First and Middle)
Title
Principal Name (Last, First and Middle)
*Example: Office Staff - reception, accounting, data entry, mechanic.
**The professional qualifications requirement for the mechanic must be of the applicant or its employees.
Title
Broker Business Name
Business Address City
State/Province
Country
Zip Code
Filer
Code
(Custom Broker Filer Code)
Contact Info
Last First
Telephone Number Fax Number
Surety Business Name
Business Address City
State/Province
Country
Zip Code
Surety
Code
(CBP Assigned Surety Code)
Contact Info
Last First
Telephone Number Fax Number
Business Name
Business Address City
State/Province
Zip Code
Contact Info
Last First
Telephone Number Fax Number
ICI Name
Business Address
City
State
Country
Zip Code
Contact Info
Last First
Telephone Number
Fax Number
(§ 592.5(a)(3)) Identity of Person preparing this statement (if different from RI.)
Name Title
Business Address City
State/Province Country
Zip Code
Applicant's Signature Date
(Signature must be acknowledged by a notary (§ 592.5(A)(12))
Notary's Signature
Date
√ N/A |
No. |
Enclosures with the following material or information should accompany the Notification of Business Change |
|
|
|
1 |
A narrated digital DVD video that shows the facilities the applicant proposes to use to conduct its business as an RI. This must be formatted to play in Windows Media Player® or in QuickTime®. Suitable video formats include MPEG® and AVI. The recording must include footage of the office space and office equipment the applicant will use in its RI business, including file cabinets or other devices that will be used to store the records an RI must maintain. The recording must also show the area outside the building as having secure vehicle storage space and the premises inside the building that will be used for performing conformance modifications on imported nonconforming vehicles. (§ 592.5(a)(9)(ii)) |
|
|
2 |
If the applicant is a non-public corporation, the applicant must provide a statement issued by the Office of the Secretary of State, or other responsible official of the State in which the applicant is incorporated, certifying that the applicant is a corporation in good standing. The application also must include the full name, street address, and date of birth of each officer, director, manager, and person who is authorized to sign documents on behalf of the corporation and the name of any person who owns or controls 10% or more of the corporation. (§ 592.5(a)(4)(iii)) |
|
|
3 |
If the applicant is a public corporation, the applicant must include a copy of its latest 10 -K filing with the Securities and Exchange Commission, and provide the name and address of any person who is authorized to sign documents on behalf of the corporation. (§ 592.5(a)(4)(iv)) |
|
|
4 |
If the applicant is a corporation not organized under the laws of a State of the United States, or is a sole proprietorship or partnership located outside the United States, the application must be accompanied by the applicant's designation of a permanent resident of the U.S. as the applicant's agent for service of process in the form specified by 49 CFR § 551.45. (§ 592.5(a)(5)(v)) |
|
|
5 |
A copy of the Safety Recall Service Contract the applicant has entered with an independent insurance company, with notarized signatures, to cover the obligations the applicant will incur as an RI with respect to conducting safety recall campaigns. (§ 592.5(a) (8)) |
|
|
6 |
A copy of the current business license issued to the applicant to do business as an importer or modifier or seller of motor vehicles or a statement that the applicant has made a bona fide inquiry and is not required by State or local authority to have such a license or document. (§ 592.5(a)(5)(iii)) |
|
|
7 |
Information sufficient to establish that the applicant is technically able to modify any nonconforming motor vehicle to all applicable Federal motor vehicle safety and bumper standards. This information should include, but not be limited to, the professional qualifications of the applicant and its employees at the time of the application (such as whether any such persons have been licensed as mechanics), and a description of their experience in conforming and repairing vehicles. (§ 592.5(a)(9)(i)) |
|
|
8 |
Information sufficient to establish that the applicant is able to acquire and maintain information regarding the vehicles that it imports and the names and addresses of the owners of the vehicles that it imports or for which it furnishes certificates of conformity to NHTSA in order to notify such owners when a noncompliance or a defect related to motor vehicle safety has been determined to exist in such vehicles. (§ 592.5(a)(9)(iv)) |
PAPER
REDUCTION
ACT
STATEMENT:
A
federal
agency
may
not
conduct or
sponsor,
and
a
person
is
not
required
to
respond
to,
nor
shall
a
person
be
subject
to
a
penalty
for
failure
to
comply
with,
a
collection
of information
subject
to the requirements
of
the
Paperwork
Reduction
Act
unless
that collection
of
information
displays a current
valid
OMB
Control
Number.
The
OMB
Control
Number
for
this
information
collection
is 2127-0002.
The
information
collected on
this
form
is
necessary
to
[INSERT
TEXT].
The
information
is
used
[INSERT
TEXT].
We
estimate
that
it
will
take
approximately
10 hours to complete
the form. The
information
collected
is
[mandatory/voluntary/required to obtain a benefit; if
mandatory
or required
for
benefit, cite
statute
or regulation].
Send
comments
regarding
this
burden
estimate or any other aspect of this
collection
of information,
including
suggestions
for reducing
this
burden
to: Information Collection
Clearance
Officer,
National
Highway
Traffic
Safety
Administration,
1200
New
Jersey
Ave,
S.E.,
Room
W45-205,
Washington,
DC,
20590.
NHTSA Form 1483
Page
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 2021-01-20 |