ANNEX X

1. | The establishment or undertaking issuing this certificate 1.1 | Name | 1.2 | Address | 1.3 | Phone number | 1.4 | Email [if available] | 1.5 | Registration or identification number (*1) | 2. | Competent authority who issued a permit for the establishment or undertaking referred to in point 1 2.1 | Member State | 2.2 | Name | 2.3 | Address | 3. | Certificate of destruction 3.1 | Date of issue | 3.2 | Number | 4. | Information on the vehicle this certificate of destruction is issued for 4.1 | Nationality mark | 4.2 | (A) Registration number (*2) | 4.3 | (J) Category (*2) | 4.4 | (D.1) Make (*2) | 4.5 | (D.3) Commercial name (*2) | 4.6 | (E) Vehicle Identification Number (*2) | 4.7 | Number of registration certificate | 5. | Information on the owner of the vehicle | 5.1 | (C.2.1) Surname or business name (*2) | 5.2 | (C.2.2) Other name(s) (*2) | 5.3 | (C.2.3) Address (*2) | 5.4 | Phone number [if available and upon consent of the owner] | 5.5 | Email [if available and upon consent of the owner] | 6 | Remarks (*1) This requirement may be waived in the case where the national registration or identification system does not provide for such number. (*2) Harmonised community codes as referred to in Directive 1999/37/EC.

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Source: EUR-Lex (Cellar) · retrieved 2026-10-14 · Text as adopted (Official Journal); later amendments are not incorporated in this text.