Red/black dot entries:

PRACOVNÍ KOPIE

HISTORIC Technical passport – Valid in: & &

This Technical Passport is not a certificate of authenticity, nor does it in anyway verify the history of the car or its constituent parts. A Technical Passport merely confirms that at the date of the inspection, the car appeared to be eligible to compete in FIA-sanctioned events for historic vehicles. Neither the FIA nor the ASN certifies or takes responsibility for the accuracy of the chassis number.

The items shown below as "asserted" are those claimed by the owner based upon his best available knowledge.

Issuing ASN:	Form Number:	Category:
Period: - to	valid to 31.12.	FIA Class:

THE ORIGINAL OF THIS DOCUMENT WAS COMPLETED IN ACCORDANCE WITH APPENDIX "K" TO THE INTERNATIONAL SPORTING CODE, FOR CARS TAKING PART IN HISTORIC COMPETITIONS. THIS CERTIFIED COPY OF THE ORIGINAL FORM REMAINS THE PROPERTY OF THE FIA AND, IF REPLACED WITH A NEW FORM, MUST BE RETURNED TO THE ISSUING ASN WHICH HOLDS THE ORIGINAL. During the whole event the car must conform to all the declarations of this HTP.

Make asserted:	Manufacturer asserted:
Model asserted:	Date of original manufacture asserted:	Year of specification:
Engine type:	FIA identity n°:
Engine capacity: cm3 corrected: cm3	Vehicle chassis / VIN n°:
FIA homologation form number (if applicable):	Number of relevant valid pages of homologation form:

BAREVNÁ FOTOGRAFIE VOZU V SOUČASNÉM STAVU Digitální fotografie ve vyhovujícím rozlišení 9 cm x 13 cm ¾ přední pohled z pravé strany kompletního vozu

Each page of this form, as well as the edge of each photograph, must bear the stamp of the issuing ASN

We, the , have checked the information given on this form and confirm that to the best of our knowledge and belief, the car complies with the period specification of the make and model represented.
Date:	Signature and stamp:	Name and status of signatory:

FIA HTP vignette

Page1

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

BAREVNÁ FOTOGRAFIE VOZU V SOUČASNÉM STAVU Digitální fotografie ve vyhovujícím rozlišení 9 cm x 13 cm ¾ zadní pohled z levé strany kompletního vozu

In case of homologated car only: if extensions of the original homologation form are used (in accordance with Appendix K), their numbers must be entered below:

In case of homologated cars bodywork may only be altered on Competition Grand Touring Cars (GTS) before Period G and on Competition Touring and GTS cars from Period G onwards according to Appendix J of the period. For the avoidance of any doubt there must be attached to this document evidence of Period Specification of changed bodywork according to Appendix K, over stamped by the issuing ASN as authorisation.

In any case for non homologated cars a period picture of the model has to be shown below.

DOBOVÝ SNÍMEK KAROSERIE VOZU Homologované vozy. Mimo jiné uveďte i dobový snímek vozu, obzvláště pokud to může doložit zbarvení vozu. 9 cm x 13 cm

Period image. Event: ……………………………………; date of the event:………………………

IMPORTANT: If this model has no International History, tick this box:

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

1 – CHASSIS, suspension

1.1	cHASSIS FRAME

[a]	Is the car fitted with a chassis to the period specifications? yes no
[b]	Clarification:
[c]	Construction (girder, tubular, monocoque, etc.):
[d]	Materials:
[e]	Note position of all identification numbers on the car:

1.2	FRONT SUSPENSION

[a]	Is the suspension as per the period specifications and dimensions? yes no
[b]	Clarification:
[c]	Type of suspension (rigid axle, wishbones, de Dion, etc.):
[d]	Type of spring (coil, leaf, torsion bar, etc.):
[e]	Type of dampers (friction, lever, telescopic, etc.):
[f]	Are the dampers adjustable? yes no
[g]	If yes to [f], state the number of adjusters per damper:
[h]	Material of the dampers: Steel Aluminium
[i1]	Is the geometry of suspension adjustable? yes no
[i2]	Is the height of suspension adjustable? yes no
[j]	If yes to [i1] and/or [i2], specify the method (Uniball joints, different mountings, etc.): i1: i2:
[k]	Is it fitted with an anti-roll bar? yes no
[l]	If yes, is this bar adjustable? yes no
[m]	Are sensors fitted? yes no
[n]	If yes, list the sensors:

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

BAREVNÝ SNÍMEK PŘEDNÍHO ZAVĚŠENÍ Digitální fotografie ve vyhovujícím rozlišení demontované kolo; brzdový systém a zavěšení musí být jasně viditelné. V případě bubnových brzd musí být buben demontován a viditelný na snímku 9 cm x 13 cm

BAREVNÝ SNÍMEK PŘEDNÍHO ZAVĚŠENÍ Digitální fotografie ve vyhovujícím rozlišení za brzdovým systémem v podélné ose vozidla 9 cm x 13 cm

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

1.3	REAR Suspension

[a]	Are the suspension and dimensions as per the period specifications? yes no
[b]	Clarification:
[c]	Type of suspension (rigid axle, wishbones, de Dion, etc.):
[d]	Type of spring (coil, leaf, torsion bar, etc.):
[e]	Type of dampers (friction, lever, telescopic, etc.):
[f]	Are the dampers adjustable? yes no
[g]	If yes to [f], state the number of adjusters per damper:
[h]	Material of the dampers: Steel Aluminium
[i1]	Is the geometry of suspension adjustable? yes no
[i2]	Is the height of suspension adjustable? yes no
[j]	If yes to [i1] and/or [i2], specify the method (Uniball joints, different mountings, etc.): i1: i2:
[k]	Is it fitted with an anti-roll bar? yes no
[l]	If yes, is this bar adjustable? yes no
[m]	Are sensors fitted? yes no
[n]	If yes, list the sensors:

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

BAREVNÝ SNÍMEK ZADNÍHO ZAVĚŠENÍ Digitální fotografie ve vyhovujícím rozlišení demontované kolo; brzdový systém a zavěšení musí být jasně viditelné. V případě bubnových brzd musí být buben demontován a viditelný na snímku 9 cm x 13 cm

BAREVNÝ SNÍMEK ZADNÍHO ZAVĚŠENÍ Digitální fotografie ve vyhovujícím rozlišení za brzdovým systémem v podélné ose vozidla 9 cm x 13 cm

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

2 – ENGINE

2.1	ENGINE

[a]	Is the engine as per the period specifications for this chassis? yes no
[b]	Clarification:
[c]	Is the position of the engine as per the period specifications? yes no
[d]	Clarification:
[e]	Is the cylinder block cast using the period specification material and dimensions? yes no Specify material:
[f]	Clarification:
[g]	Is the cylinder head cast using the period specification material and dimensions? yes no Specify material: Casting number:
[h]	Clarification::
[i]	Make:	Casting number of the block:
[j]	Year of manufacture:	Operating method:
[k]	Number of cylinders:	Configuration (straight, V, etc.):
[l]	Bore: original: mm	Stroke: original: mm
actual: mm	actual: mm
[m]	Engine capacity: original: cm3	actual: cm3
[n]	Number of intake ports: Number of plugs per cylinder: Number of exhaust ports: Number of valves per cylinder: Number of transport port (in case of two stroke engines): Number of rotors (in case of wankel/rotary engine):
[o]	Valve sizes to period specifications? yes no
[p]	Clarification:
[q]	Are sensors fitted? yes no
[r]	If yes, list the sensors:

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

2.2	IGNITION

[a]	Is the system as per the period specifications? yes no
[b]	Clarification:
[c]	Type (magneto, breaker/coil, etc.):
[d]	If the ignition is electronic, specify the make and principal:
[e]	Are sensors fitted? yes no
[f]	If yes, list the sensors:

2.3	FUEL FEED

[a]	Are the make, type and number of carburettors / injection as per the period specifications? yes no
[b]	Clarification:
[c]	Carburettor: Number: Make: Type: ø of venturi in mm:
[d]	Injection : Make: Type:
[e]	If an air restrictor is fitted, diameter of the restrictor: mm
[f]	If supercharged, is the supercharger as per the period specifications? yes no
[g]	Clarification:
[h]	Supercharger: Make: Type: Number:
[i]	If an air cooler is fitted, is it as per the period specifications? yes no
[j]	Clarification:
[k]	Are sensors fitted? yes no
[l]	If yes, list the sensors:

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

2.4	FUEL SYSTEM

[a]	Is the fuel system as per the period specifications? yes no
[b]	Clarification:
[c]	Type of fuel feed (gravity, mechanical pump, electric pump, etc.):
[d]	Is a fuel cooler fitted yes no
[e]	Is the fuel tank as per the period specification's location? yes no Does it comply with Appendix K? yes no
[f]	Clarification:
[g]	Are sensors fitted? yes no
[h]	If yes, list the sensors:

2.5	Lubrication

[a]	Is the system as per the period specifications? yes no
[b]	Clarification:
[c]	Type (wet sump, dry sump, etc.):
[d]	Is an oil cooler fitted? yes no
[e]	If yes, is the cooler as per the period specifications? yes no
[f]	If no, specify and justify the changes in relation to the period specification:
[g]	Is a main circuit oil filter fitted (pre-war cars only)? yes no
[h]	Are sensors fitted? yes no
[i]	If yes, list the sensors:

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

BAREVNÁ FOTOGRAFIE MOTORU ukazující celou zástavbu motoru z levé strany Digitální fotografie ve vyhovujícím rozlišení 9 cm x 13 cm

BAREVNÁ FOTOGRAFIE MOTORU ukazující celou zástavbu motoru z pravé strany Digitální fotografie ve vyhovujícím rozlišení 9 cm x 13 cm

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

3 – Transmission

3.1	GEARBOX

[a]	Is the gearbox as per the period specifications? yes no
[b]	Clarification:
[c]	Make: Type:
[d]	Number of forward gears: reverse gear: yes no
[e]	Number of teeth (for homologated cars only): 1st gear: 2nd gear: 3rd gear: 4th gear: 5th gear: 6th gear: Constant: alternatives listed in section 9
[f]	Is an oil cooler fitted? yes no
[g]	If yes, is it as per the period specifications? yes no
[h]	Are sensors fitted? yes no
[i]	If yes, list the sensors:

3.2	FINAL DRIVE

[a]	Driven wheels: Front: Rear:
[b]	Drive method (shaft, chain, etc.):
[c]	Is the final drive ratio as per the period specifications? yes no
[d]	Specify the number of teeth used:
[e]	Specify the other number of teeth available as period specifications: - - - - - - - - - - - - - - - -
[f]	Is the differential a limited slip differential? yes no
[g]	If yes: Make: Model: System:
[h]	Is an oil cooler fitted? yes no
[i]	If yes, is it as per the period specifications? yes no
[j]	Are sensors fitted? yes no
[k]	If yes, list the sensors:

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

4 – BRAKES AND STEERING

4.1	BRAKES

[a]	Is the braking system as per the period specifications? yes no
[b]	Clarification:
[c]	Actuation (cable, rod, hydraulic, etc.): Front: Rear: Other option:
[d]	Is the braking system assisted? yes no Other option:
[e]	Specify the system:
[f]	Make: Front: Rear:
[g]	If drum brakes: Drum diameter Front: mm Rear: mm Other: mm
Shoe width Front: mm Rear: mm Other: mm
[h]	If disc brakes: Disc diameter Front : mm Rear: mm
Max. disc thickness Front: mm Rear: mm
Ventilated disc: Front: yes no Rear: yes no
Callipers: Material at front: Number of pistons per front calliper:
Material at rear: Number of pistons per rear calliper:
[i]	Are sensors fitted? yes no
[j]	If yes, list the sensors:

4.2	STEERING

[a]	Is the steering as per the period specifications? yes no
[b]	Clarification:
[c]	Type (rack and pinion, worm and roller, etc.):
[d]	Is the steering assisted? yes no
[e]	Specify the system:
[f]	Are sensors fitted? yes no
[g]	If yes, list the sensors:

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

5 – WHEELS

5.1	WHEELS

[a]	Are the wheels as per the period specifications? yes no
[b]	Clarification:
[c]	Are the wheels in multiple parts? yes no
[d]	Are the diameter and the width of the wheels as per the period specification? yes no
[e]	Clarification:
[f]	Type and material (wire, pressed steel, alu alloy, magnesium alloy, etc.): Front: Rear:
[g]	Diameters / widths of rims at the front (specify the units: inches or millimetres):
1. Diameter: Width: 2. Diameter: Width:
3. Diameter: Width: 4. Diameter: Width:
[h]	Diameters / widths of rims at the rear (specify the units: inches or millimetres):
1. Diameter: Width: 2. Diameter: Width:
3. Diameter: Width: 4. Diameter: Width:
[i]	Are sensors fitted? yes no
[j]	If yes, list the sensors:

6 – BODYWORK, LIGHTING

6.1	BODY

[a]	Is the body the original one for that chassis? yes no
[b]	If no, is the body as per the period specifications? yes no
[c]	Clarification:
[d]	Is all the material of the body as per the period specifications? yes no
[e]	Main material: If other material used specify material and body parts:
[f]	Type (single-seater, coupé, etc.):
[g]	Number of seats:
[h]	Number of doors:

6.2	AERODYNAMIC DEVICES (cars built after 1965 only)

[a]	Are these devices as per the period specifications? yes no
[b]	Clarification:
[c]	Measurements see extension “Aerodynamic Devices (MeasurementS)”

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

6.3	LIGHTING

[a]	Is the lighting as per the period specifications? yes no
[b]	If no, specify and justify the changes in relation to the period specification:
[c]	Is generator fitted? yes no
[d]	If yes, type: dynamo alternator other, specify and justify:

7 – Dimensions

7.1	Dimensions

[a]	Wheelbase: left: mm right: mm
[b]	- Track (measured between the centres of the tyre treads): - or Body width at centre line of axles for homologated cars from Period G2 onwards Original front: mm Current front: mm Original rear: mm Current rear: mm
[c]	Minimum weight: kg

8 – DRAWINGS AND/OR PiCtures

If necessary, drawings and/or pictures of the aerodynamic devices, suspension, etc

9 – ADDITIONAL PIECES OF INFORMATION

If necessary, list of alternatives (gearbox ratios, etc)

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

10 – Technical regulations

- The car must comply with the technical regulations for Group of Appendix 19 .

- Or, the car must comply with the following technical regulations: (from 19 ).

The regulations of current appendix K have priority.

11 – Competitor’S Declaration

We certify that the answers given are correct, and we undertake to notify the authorising ASN should any changes be made. We FURTHERMORE accept that if at a later date our answers are shown to have been knowingly INCORRECT or inaccurate that this HTP will be immediately cancelled. We also certify that any entry form for an FIA international event will be filled in according to the information given on the present form.

Name of the car owner:
Full address:
Licence number (if applicable):

Date:	Signature:

CAUTION: This document is intended solely to verify that, at the date of the inspection, the car appears to be eligible to compete in FIA-sanctioned events for Historic Vehicles (as defined in the International Sporting Code). It makes no representation as to guarantee the authenticity or history of the car. For example, a part which appears to be manufactured to original specification was not necessarily fitted to this car at the time of original manufacture, and the car may have been modified since the date of the inspection. The ASN has not inspected the car for any purpose other than that specified above, and accepts no liability for the accuracy or otherwise of any information contained in this form. Such information has been supplied by the owner of the car, who remains solely responsible for its accuracy.

12 – Change in ownership

Name of the new car owner:
Full address:
Licence number (if applicable):
Name of the new car owner:
Full address:
Licence number (if applicable):
Name of the new car owner:
Full address:
Licence number (if applicable):

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

13 – ELIGIBILITY CHECKS

If the car that is presented for an event is not in conformity with its HTP, refer to article 4.3 of Appendix K.

This table, to be filled in only by FIA event officials and only when necessary, serves to record any comments made subsequent to scrutineering at FIA international events.

Date	Venue	Comments	Name and status of the official

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

14 – LOG Book

This table is not compulsory but may be filled in by Scrutineers (not FIA officials only)

Date	Venue	Comments (e.g. heavy damage after crash or safety errors)	Signature of the official

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

Extension – Non homologated cars

This extension is an addition to the basic Historic Technical Passport for non homologated cars, for Group 5 cars and post-1992 GT cars

BAREVNÁ FOTOGRAFIE VOZU V SOUČASNÉ PODOBĚ Digitální fotografie ve vyhovujícím rozlišení 9 cm x 13 cm přední pohled na kompletní vůz

BAREVNÁ FOTOGRAFIE VOZU V SOUČASNÉ PODOBĚ Digitální fotografie ve vyhovujícím rozlišení 9 cm x 13 cm zadní pohled na kompletní vůz

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

BAREVNÁ FOTOGRAFIE VOZU V SOUČASNÉ PODOBĚ Digitální fotografie ve vyhovujícím rozlišení 9 cm x 13 cm boční pohled na kompletní vůz

BAREVNÁ FOTOGRAFIE PŘÍSTROJOVÉ DESKY Digitální fotografie ve vyhovujícím rozlišení 9 cm x 13 cm

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

BAREVNÁ FOTOGRAFIE KOMPLETNÍ KAPOTY Digitální fotografie ve vyhovujícím rozlišení 9 cm x 13 cm

BAREVNÁ FOTOGRAFIE KOMPLETNÍ PODLAHY Digitální fotografie ve vyhovujícím rozlišení 9 cm x 13 cm

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

BAREVNÁ FOTOGRAFIE PŘEVODOVKY Digitální fotografie ve vyhovujícím rozlišení 9 cm x 13 cm

BAREVNÁ FOTOGRAFIE ROZVODOVKY Digitální fotografie ve vyhovujícím rozlišení 9 cm x 13 cm

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

DOCUMENTARY REFERENCES

Draw up a list of the technical and descriptive references to the car found in documents (books, periodicals, etc.) contemporary with its construction.

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

Extension – Roll Over Protection system

1.1	Roll Over Protection system

[a]	System in accordance with:

1.2	FIA Homologated system

[a]	If on FIA homologation form: Name of manufacturer:
Homologation number of the form: Number of the homologation extension:
N.B.: A copy of the extension must be attached to the HTP.

1.3	ASN certified system

[a]	If certified by an ASN: Name of the ASN:
Certificate / Test report number:
N.B.: A copy of the certificate must be attached to the HTP.

1.4	Appendix K system (self made)

[a]	Main/Lateral bar	Front bar	Diagonals	Other struts	Cross braces
Outer diameter (mm)
Wall thickness (mm)

[b]	Material specification:
[c]	Drawing numbers according to App. K - App. VI (including the basic drawings and drawings of all options used):

1.5	Period specification system

[a]	Main/Lateral bar	Front bar	Diagonals	Other struts	Cross braces
Outer diameter (mm)
Wall thickness (mm)

[b]	Material specification:
[c]	Drawing numbers according to App. K - App. VI (including the basic drawings and drawings of all options used):
[d]	Number of mounting points to bodyshell / chassis:

1.6	further information, if necessary:

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

Extension – Aerodynamic Devices (MeasurementS)

Dimensions (tolerance for all dimensions: +/-1%)

[A]	mm
[B]	mm
[C]	mm
[D]	mm
[E]	mm

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

NUMBER OF WINGS:

Dimensions (tolerance for all dimensions: +/-1%)

WING 1	WING 2	WING 3
[A]	mm	[A]	mm	[A]	mm
[B]	mm	[B]	mm	[B]	mm
[C]	mm	[C]	mm	[C]	mm
[D]	mm	[D]	mm	[D]	mm
[E]	mm	[E]	mm	[E]	mm
[F]	mm	[F]	mm	[F]	mm

Signatory ASN: PRACOVNÍ KOPIE	Form n°:

Dimensions

(tolerance for all

dimensions: +/-1%)

[A]	mm
[B]	mm
[C]	mm
[D]	mm
[E]	50 mm min.
[F]	mm
[G]	mm
[H]	mm
[I]	mm
[J]	mm
[K]	mm
[L]	mm
[M]	mm

Dimensions

(tolerance for all

dimensions: +/-1%)

[A]	mm
[B]	mm
[C]	mm
[D]	mm max.
[E]	50 mm min.
[F]	mm min.
[G]	mm
[H]	mm
[I]	mm
[J]	mm