NOTE: Declaration to Revenue is not required in most cases - Please see Notes
This form is only required to be completed upon conversion of a Foreign Registered Vehicle
prior to registration in Ireland, or an Irish Registered vehicle under the circumstances listed - See Notes section.
It must also be completed and submitted as part of certain applications under the Disabled Drivers
and Passengers (Tax Concessions) Regulations 1993 (S.I. No. 353 of 1994 (as amended)) - See Notes section.
VEHICLE CONVERSION TYPE DETAILS (please tick R as appropriate)
Foreign Registered Vehicle? OR Irish Registered Vehicle?
Application for Exemption under Disabled Drivers and Passengers Regulations? YES NO
Registration No. WLTP CO2 g / km NOx mg / km
Make: _______________________________________ Model: __________________________________________
Variant: ______________________________________ Version: _________________________________________
Mileage (distance since new): _____________________ KM Miles
(Tick R one)
Total cost of Conversion including VAT: € _____________ NB: A list of the invoices / receipts, showing dates and amounts must be attached.
I hereby declare that:
the above conversions have been carried out by a competent person,
• theconvertedvehicleconformstostandardsforuseonapublicroadassetbytheRoadTrafc(Construction,EquipmentandUseofVehicles)
Regulations, (Statutory Instrument No. 190 of 1963),
• theconversiondetailsenteredaboveareinaccordancewiththegeneraldenitions,criteriaforvehiclecategorization,vehicletypesandtypesof
• theconversionshavebeencertiedbyaSuitablyQualiedIndividualandthatcerticate,dulystamped,isattachedtothisdeclaration,
• thisdeclarationhasbeenstampedbythatSuitablyQualiedIndividual,
• Iacceptthatitisultimatelymyresponsibilitytoensurethatthisvehicle,asconverted,complieswiththerequirementsofRoadTrafclawand
Signed (Vehicle Owner): __________________________________________ Date: ____ / ____ / ____
Name (Block letters): _____________________________________________ PPSN / Tax No: ________________
Address: _______________________________________________________ Daytime Telephone No.(s):________________
______________________________________________________________ ________________
WARNING: A person knowingly concerned in evasion or taking of steps for the purposes of evasion, by himself or another, of VRT, shall be
guilty of an offence punishable on conviction with nes and imprisonment
Characteristics Original Converted
No. of seating positions
Mass in Running Order
No. of doors
No. of windows
Technically Permissible Maximum Laden Mass
of the
General Description
of Conversion
Template for Suitably Qualied Individual, Declaration of Conversion
The declaration must be drawn up on the headed paper of the SQI, which must contain the Name and / or Business Name,
address, contact details and tax number.
The declaration itself must contain the following details:
Registration No. WLTP CO2g/km NOx mg / km
I declare that I have (tick R as appropriate):
(i) anEngineering/Technicalqualication(Level7orhigheraccreditedcourses)
(ii) accreditation with Engineers Ireland as a Chartered or Associate Engineer
(iii) membership or incorporated membership of the Institute of Automotive Engineer Assessors
(iv) National Standards Authority of Ireland approval as an Approved Test Centre
(v) National Standards Authority of Ireland Approved Workshop for Conversion of Vehicles for Disabled Drivers
Number of years relevant experience: _____________________________________________________________________
Details of professional indemnity insurance: ________________________________________________________________
Location of Inspection: _________________________________________________________________________________
Where additional information is required, it should be attached as a separate page.
I hereby declare that:
• havingexaminedvehiclewithVINdetailedabove,itismyprofessionalopinionthatthisvehiclenowsatisesthe
• IamsatisedthattheconvertedvehiclemeetsallrelevantcriteriainRegulation(EU)2018/858andCommissionRegulation
the information contained in the Declaration of Conversion by Vehicle Owner duly stamped by me is true and correct,
I meet the professional requirements as set out below.
Name (Block Letters): ___________________________________ ____________________________________
Date: _____ / _____ / ______ ____________________________________
WARNING: A person knowingly concerned in evasion or the taking of steps for the purposes of evasion, by himself or
another, of vrt, shall be guilty of an offence punishable on conviction with nes and imprisonment
SQIs must have:
• anEngineering/TechnicalQualication(Level7orhigheraccreditedcourses)orappropriateaccreditationwithEngineers
Ireland or the Institute of Automobile Engineer Assessors,
• aminimumofveyearsexperienceofworkinginasuitabletechnicalenvironment(preferablyAutomotiveorEngineering
access to adequate facilities to carry out a thorough vehicle examination, and
appropriate professional indemnity insurance,
or must be a National Standards Authority of Ireland approved facility (Approved Test Centre or Approved Workshop for Conversion
of Vehicles for Disabled Drivers).
A list of NSAI ATCs and their scope is available at:cation/automotive/national-type-approva/atc/
Converted Foreign-Registered Vehicle
A vehicle owner must present the Declaration of Conversion and related Suitably Qualied Individual declaration
to the NCTS when declaring a vehicle of this type for registration.
Please see for documents which must be brought to the NCTS when presenting a vehicle for
In addition, the total cost of conversion in Euros including VAT must be supported with a list of invoices / receipts
showing dates and amounts.
Converted Irish-Registered Vehicle
Declaration To Revenue Is Not Required In Most Cases
• DeclarationisnotrequirediftheVehicleRegistrationCerticateatitemJ1(VRTvehiclecategory)shows“A”.
• DeclarationisonlyrequirediftheVehicleRegistrationCerticateatJ1shows“B”or“C”or“D”orisblank,and:
(1) seating positions have been added and the new total including the driver is nine seating positions or less;
(2) had ten seating positions or more, seating positions have been removed and the new total including the
driver is nine seating positions or less;
(3) converted to motor caravan; declaration is not required however if registered in Ireland as a car or MPV or
Only if (1), (2) or (3) above is the case, the vehicle owner must submit the Declaration of Conversion and the
related Suitably Qualied Individual declaration, andothersupportingdocumentsto:Revenue’sMyEnquiries
please send your application in a FREEPOST envelope to:
Declarations should be posted together with the following Supporting Documents:
• acopyoftheVehicleRegistrationCerticate(bothsides),
invoice(s) showing the costs of conversion,
where a vehicle is a Category A vehicle, or is being converted to a Category A vehicle evidence of NOx must be
presented, and
in the case of a Motor Caravan, photographs showing the full interior, at least one of which should be taken from
the front of the living area looking rearward and one from the rear of the living areas looking forward such that
they provide a good overview of the layout of the living accommodation. At least three photographs should be
of the exterior one of which also includes the registration plate of the vehicle. A maximum of 15 photographs in
total should be submitted.
Vehicle Conversions
Motor Caravans or Ambulances, please see the Revenue website:
Please ensure that you have read and are familiar with all of the information on that page.
Tax Relief For Vehicles For People With Disabilities
This Conversion form should be submitted as part of the following applications under the Disabled Drivers and
Passengers (Tax Concessions) Regulations 1993 (S.I. No. 353 of 1994 (as amended)), where the vehicle is:
a Converted Irish Registered Vehicle, or
a Converted Foreign Registered Vehicle, and
an application for one of the following Exemptions is being made:
o QualifyingOrganisation,
o SpecicAdaptations-Driver,
o Extensive Adaptations - Driver, Passenger or Organisation.
For details regarding Tax Relief for Vehicles for People with Disabilities, and the necessary application form and
contact details, please see the Revenue website:
Vehicle Conversion Form - Checklist
Please complete and sign this checklist, and include with your declaration.
• IhavereadandunderstandtheinformationprovidedonRevenue’sWebsite:
• Isthe‘VehicleConversionType’sectionfullycompleted?
• Isthe‘VehicleTechnicalDetails’sectionfullycompleted?
• Isthe‘ConversionDetails’sectionfullycompleted?
• HastheSuitablyQualiedIndividualstampedthedeclaration?
Have you, the Declarant, provided your Contact and PPSN / Tax Number details?
Have you, the Declarant, SIGNED and DATED the declaration?
Suitably Qualied Individual Declaration
Have the Vehicle Details been fully completed?
• HastheCompetencyoftheSuitablyQualiedbeenselected?
Has the Number of Years Relevant experience, etc. been declared?
• IsthedeclarationsignedbytheSuitablyQualiedIndividualandcontactdetailsprovided?
Accompanying Documentation
• AcopyoftheVehicleRegistrationCerticateisenclosed(convertedIrishregisteredvehicleonly)
Evidence of NOx emissions in the case of Category A vehicles, or conversions to Category A
If the Conversion relates to a Motor Caravan, have the following been enclosed with the Declaration?
Dated invoices / receipts covering the full conversion cost/s
Photographs of the converted vehicle, to include the following:
A maximum of six exterior photographs: one full side view (of each side), one full front view
with the registration number in view and one full rear view.
A maximum of nine interior photographs to include: seating positions and table, sleeping
accommodation, cooking facilities, storage facilities, the interior taken from the front
looking rearward, and of the interior taken from the rear looking forward.
Signed (Vehicle Owner): _______________________________________
Name (Block letters): __________________________________________
Date: ______ / ______ / ______
PPSN / Tax No: _____________________
Please note: If all sections are not completed and if all relevant documentation is not submitted, the declaration cannot
be processed and the declaration and all documentation will be returned to the declarant. Do not attach any staples to
any part of your application.
Designed by the Revenue Printing Centre
The Revenue Commissioners collect taxes and duties and implement customs controls. Revenue requires customers
to provide certain personal data for these purposes and certain other statutory functions as assigned by the
Oireachtas. Your personal data may be exchanged with other Government Departments and agencies in certain
will use your personal data as well as information regarding your rights as a data subject are available on our Privacy
page on Details of this policy are also available in hard copy upon request.
The information in this document is provided as a guide only and is not professional advice, including legal advice. It