Main Roads Western Australia Vehicle Register & Roadworthiness Inspection/Certification template for greater than 10 vehicles – June 2014

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WAHVA - VEHICLE ROADWORTHINESS INSPECTION/CERTIFICATION REGISTER FOR MORE THAN 10 VEHICLES

______________________________________ ____________________ _______________ Operator Business Name Operator Signature Date

Vehicle Type

(P Mover /

Trailer / Dolly)

Vehicle

Registration

Vehicle

Make Vin / Chassis No.

Year of

Manufacture

Vehicle

Owner

Roadworthy

Certificate

Date

RWC

Undertaken By Signed

VERIFICATION: Your name and signature on this form deems you are a suitably qualified person, have inspected the vehicle/s aligned with your name & signature and certify them to be roadworthy, at the corresponding Roadworthy Certificate date.