NHTSA Form 1482 Yearly Statement of Registered Import

Part 592.5(f) Yearly Statement of Registered Importer

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/

(Must complete this entire form) NHTSA Form 1482

Section I. Registered Importer Information

Applicant Name:

Last First

Middle

Date of Birth:

Position:

Business Name:

Business Address: City:

State:

Country

Zip Code:

Telephone Number: Fax Number:

E-mail Address:

Form of Business Organization:

State under which business formed:

Section II. Principals of the Applicant whom the Applicant Authorizes to submit Conformity Certifications to NHTSA

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.

Section III. List of Employees

(Attach a separate page if there are more than 4 employees)

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

*Example: Office Staff - reception, accounting, data entry, mechanic.

**The professional qualifications requirement for the mechanic must be of the applicant or its employees.

Section IV. Certification, Acknowledgement & Disclosure

Section V. Documentation Preparation & Enclosures

(§ 592.5(a)(3)) Identity of Person preparing this statement (if different from RI.)

Name

Last First Middle

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

Section VI. Yearly Statement of Registered Importer Checklist

√ N/A		No.	Enclosures with the following material or information should accompany the "Yearly Statement of Registered Importer "
		1	A cashiers check or certified check or authorized credit card on file made payable to the Treasurer of the United States in the amount specified under 49 CFR Part 594 to cover the cost of the application. (§ 592.5(a)(7))
		2	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))
		3	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))

PAPERWORK 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 renew a registration with NHTSA as an importer of motor vehicles that are not originally manufactured to comply with all applicable Federal motor vehicle safety standards. The information is used to verify the importer's eligibility to renew its registration. We estimate that it will take approximately 2 hours to complete the form. The information collected is necessary to obtain a benefit under 49 U.S.C. § 30141(c) and 49 CFR 592.5(f). 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 1482

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