Safety Certificate

Cars or Light Commercial Vehicles

(up to and including 4.5 tonne RGVM)
Transport Operations (Road Use Management) Act 1995

Unassigned Safety Certificate

Assigned Inspection Certificate Certificate Number

It is recommended that this certificate is presented when registering or

LV - P 064480 9
transferring your vehicle. Until this certificate is presented at a Department of
Transport and Main Roads Customer Service Centre, the vehicle registration cannot be transferred
online. For more information about online transfers, visit www.qld.gov.au/onlineregotransfer.

Vehicle details First inspection - Passed Inspection

Plate number: CYA28X Odometer reading Inspection date and time
State: Queensland 43500km 10:45 am, 16/04/2016
VIN/Chassis number: 1HGBH41JXMN109186
Make: TOYOTA MOTOR Identification
Model: CORPORATION Modification Failed/then passed
Body shape: LS400 20 SER Seats and Restraints
Series: EA Lights and Electrical Components
Badge: LX Windscreen and Windows
Number of cylinders/rotors: 4 Body and Chassis
Fuel type: Petrol Steering and Suspension
Number of doors: 5 Wheels and Tyres
Engine number: 45578112112 Brakes components
Compliance type: Compliance Plate Engines and Drivelines
Date on plate: 1/1997 Exhaust Emissions
Vehicle colour: Silver Road Test
Seating capacity: 5 Service Brake Test: Peak - 75%
Steering position: Centre Average - 65%
Tare: 3400kg Hand brake test: Peak - 85%
GVM: 4500kg Distance - 8m

Inspection Station and Examiner details

AIS name: Kmart Tyre & Auto Service Name of Examiner: B Nash
AIS number: S38393 Examiner’s number: 2383773
AIS address: Shell Coles Express Service Station Mobile AIS Rego No: M29332
29 Gailey Road Mobile AIS location: 15 Grand Plaza Drv
St Lucia, QLD, 4068 Browns Plains, QLD, 4117

● This safety certificate does not need to be displayed on the vehicle offered for sale.
● You must produce this safety certificate for inspection by the prospective buyer or buyer's agent on request.
Note: Failure to produce this certificate may result in enforcement action.
● This safety certificate is valid for:
○ Licensed Motor Dealers – 3 months/1000km
○ Private Sales – 2 months/2000km
Note: The validity of this safety certificate is determined by whichever occurs first.
● This safety certificate can only be used once for a sale/transfer. (Excluding sales/transfers between licensed motor dealers).
● This certificate or certificate number must be provided to the acquirer of the vehicle at transfer of registration.

Privacy statement: The Department of Transport and Main Roads is collecting this information on this form for the purposes of managing the department's vehicle
register. This information is authorised or required by the Transport Operations (Road Use Management) Act. The department or its agents usually gives some or all of
this information to vehicle insurers, statutory entities, lawyers, insolvency entities, persons involved in vehicle accidents/incidents or vehicle manufacturers or their
employees or agents and to or through interstate registration authorities. Your personal details will not be disclosed to any third party without your consent unless
required or authorised by law.

TRB Forms Area Form F2498_ICOLVUN V01 July 2016

 Inspection Report
Cars or Light Commercial Vehicles
(up to and including 4.5 tonne RGVM)
Transport Operations (Road Use Management) Act 1995

Inspection Report Number

LV - P 064480 9

Vehicle details First inspection - Failed Inspection

Plate number: CYA28X
State: Queensland Vehicle required for re-inspection within 14 days
VIN/Chassis number: 1HGBH41JXMN109186 If vehicle is not re-inspected within 14 days a new full inspection
Make: TOYOTA MOTOR including payment is required
Model: CORPORATION
Body shape: LS400 20 SER Odometer reading Inspection date and time
Series: EA 43500km 10:45 am, 16/04/2016
Badge: LX
Number of cylinders/rotors: 4 Identification
Fuel type: Petrol Modification
Number of doors: 5 Seats and Restrains
Engine number: 45578112112 Lights and Electrical Components
Compliance type: Compliance Plate Windscreen and Windows
Date on plate: 1/1997 Body and Chassis
Vehicle colour: Silver Steering and Suspension
Seating capacity: 5 Wheels and Tyres
Steering position: Right Brakes components
Tare: 3400kg Engines and Drivelines
GVM: 4500kg Exhaust Emissions
Road Test
Service Brake Test: Peak - 75%
Inspection Station and Distance - 10m
Examiner details Hand brake test: Peak - 85%
Average - 70%
AIS name: Kmart Tyre & Auto Service
AIS number S38393 Details of other items rejected: Exhaust System leaks
AIS address: Shell Coles Express Service Inspection comments
Station, 29 Gailey Road, Excessive brake pedal travel, less than 20% of travel remains
St Lucia, QLD 4068
Name of Examiner: B Nash
Examiner’s number: 2383773
Mobile AIS Rego No: M29332
Mobile AIS location: 15 Grand Plaza Drv
Browns Plains, QLD, 4117

Details of Failed Inspection

1.2 Seat Belts
1.2.1 Original manufacturer’s seat belts are missing or replacement belts do not meet the vehicle manufacturer’s specifications.
1.2.5 When extended, the seat belt sash does not retract (the speed of retraction should not be a cause for rejection unless it
affects the overall operation of the seat belt assembly in any way).

2.7 Battery
2.7.3 Batteries fitted in enclosed areas (i.e boot, cabin and so on) are not fitted in a sealed container which is adequately vented to
the outside of the vehicle.

3.1 Windscreen and Glazing

Privacy statement: The Department of Transport and Main Roads is collecting this information on this form for the purposes of managing the department's vehicle
register. This information is authorised or required by the Transport Operations (Road Use Management) Act. The department or its agents usually gives some or all of
this information to vehicle insurers, statutory entities, lawyers, insolvency entities, persons involved in vehicle accidents/incidents or vehicle manufacturers or their
employees or agents and to or through interstate registration authorities. Your personal details will not be disclosed to any third party without your consent unless
required or authorised by law.

Page 1 of 2 TRB Forms Area Form F2498_ICOLVIR V01 July 2016

3.1.7 The area of windscreen swept by the wipers to the right of the centre of the vehicle has bull’s-eyes or star fractures more than
16mm in diameter or cracks more than 150mm long which either penetrate more than one (1) layer of the glass in a
laminated windscreen or interfere with the driver’s vision.
3.1.10 Anything is fitted to the windscreen or vehicle that obstructs the driver’s vision through the swept area of the windscreen.
3.1.13 At least half of the number of windows which are designed to be opened, which must include the driver’s window, are not
capable of being opened.

Page 2 of 2 TRB Forms Area Form F2498_ICOLVIR V01 July 2016