G2. Page 1 of 4
Form G2, date of issue 2006-04-27 Applications for derogation from TSI – see Chapter 3 of the Guide to approvals.
Date:...... Applicant • Name of operator :...... Contact:...... (name, title/function) - Phone:...... - E-mail:...... Postal address:...... Postcode and town: ...... Visiting address:...... Company reg. no.:...... Part of which group (if any): ...... Phone:...... Fax:...... Website:...... E-mail:......
The application relates to:
Specify the TSI(s) to which the application relates:......
Included in/operates on Not included in/does not TEN networks operate on TEN networks
The derogation concerns deviation from the following parts of a TSI or TSI(s): (If the derogation does not relate to an entire TSI, enter the relevant section(s) of the TSI(s)
Deviation 1:...... Deviation 2:...... Deviation 3:...... Deviation 4:...... Deviation 5:...... G2. Page 2 of 4
Provisional date for inauguration with derogation:......
Planned date(s) for compliance with TSI(s): Deviation 1:...... Date:...... Deviation 2:...... Date:...... Deviation 3:...... Date:...... Deviation 4:...... Date:...... Deviation 5:...... Date:......
Reason for the application: (The possible options are described in Section 3.1 of the Guide, for example “the project has gone too far”. These options can be invoked when the subsystem forms part of the TEN. The reason must be described in greater detail in an attachment. The option “Other” may only be invoked when the subsystem does not form part of the TEN.)
Case a) in Section 3.1 of the Guide
Case b) in Section 3.1 of the Guide
Case c) in Section 3.1 of the Guide
Case d) in Section 3.1 of the Guide
Other:......
Previous approvals:
Derogation from complying with the requirements of TSIs:...... (by the Swedish Rail Agency) (date/reference number)
Other information:
Infrastructure manager/ railway undertaking/client:...... (to be stated if these are not the same as the applicant and if these have been determined) G2. Page 3 of 4
Outline description:
Railway infrastructure:
Place or stretch of line*):...... Version designation (if any) *):...... Contractor/resp. for constr. :...... Inspector:...... (inspection before inauguration) Brief description*):...... (may also be supplied in the form of a separate attachment)
Area of use (freight/passenger transport/mixed traffic) :
Vehicle:
Vehicle designation/machine type*):...... Vehicle number/serial number*):...... Brief description*):...... (may also be supplied in the form of a separate attachment) Version designation:...... Type designation (suggested) :...... Manufacturer:...... Year of manufacture:...... Intended for type of traffic:......
*) Mandatory information G2. Page 4 of 4
Schedule for submitting documentation (attachments to form G2) List the attachments sent with this application and state an estimated date when the documents will be submitted.
Attach- Provisional ID Put a cross here ment date no. A description of the subsystem, including a plan, A geographical location, functional and technical scope. Details of the TSI(s) from which derogation is requested B and whether the application applies to parts or all of the TSI(s). Statement of the reasons (technical, administrative C and/or financial) for the application for derogation. Statement of the corresponding specifications that the D applicant wishes to apply. Action plan setting out the measures the applicant is taking and will take to achieve, in due course, E compliance with the part or parts of the TSI to which the application for derogation relates. Other attachments: F G H I J