If you use assistive technology (such as a screen reader) and need a
version of this document in a more accessible format, please email firstname.lastname@example.org.
Please tell us what format you need. It will help us if you say what assistive technology you use.
This form is used at an annual test if a PSV appears to require a speed limiter but the presenter wishes to declare it exempt.
PSV speed limiter exemptions can be granted if the vehicle:
has been modified so as not to be capable of relevant speed
is incapable of relevant speed by its original design