SCHEDULE 3 Regulation 23
FORMS OF MEASUREMENT TICKETS
Form 1
Ticket No. ..........................
Date ..................................
REGISTERED PUBLIC WEIGHBRIDGE NO. ...............................
( Here state the name of the holder of the public weighbridge licence )
........................................................................................................................
........................................................................................................................
( Here state the location of the weighbridge ) .................................................................
DIRECT MEASUREMENT
Goods measured ...................................................................................................
Marks and brands on goods measured .........................................................................
Place of despatch of goods measured ..........................................................................
Destination of goods measured .................................................................................
Registered No. or Nos. of vechicle measured ................................................................
Name of driver of vehicle .......................................................................................
Tonnes | |
Gross mass | |
Tare mass | |
Net mass |
.............................................................
(Signature of operator)
Form 2
Ticket No. ..........................
Date ..................................
REGISTERED PUBLIC WEIGHBRIDGE NO. ...............................
( Here state the name of the holder of the public weighbridge licence )
........................................................................................................................
........................................................................................................................
( Here state the location of the weighbridge ) .................................................................
DIRECT MEASUREMENT
Goods measured ...................................................................................................
Marks and brands on goods measured .........................................................................
Place of despatch of goods measured ..........................................................................
Destination of goods measured .................................................................................
Registered No. or Nos. of vehicle measured .................................................................
Name of driver of vehicle ........................................................................................
Kilograms | |
Gross mass | |
Tare mass | |
Net mass |
.............................................................
(Signature of operator)
Form 3
Ticket No. ..........................
Date ..................................
REGISTERED PUBLIC WEIGHBRIDGE NO. ...............................
( Here state the name of the holder of the public weighbridge licence )
........................................................................................................................
........................................................................................................................
( Here state the location of the weighbridge ) .................................................................
AXLE MASSES ONLY
Registered No. or Nos. of vehicle measured .................................................................
Name of driver of vehicle .......................................................................................
Axle No. | Tonnes (including |
If 2 or more axles are | | | 1 | | | |
measured together, | | | 2 | | | |
this is to be shown | | | 3 | | | |
by bracketing | | | 4 | | | |
the relevant axle | | | 5 | | | |
numbers. | | | 6 | | | |
.............................................................
(Signature of operator)
MASSES SHOWN ON THIS
TICKET ARE NOT TO BE
USED FOR
TRADE.
Form 4
Ticket No. ..........................
Date ..................................
REGISTERED PUBLIC WEIGHBRIDGE NO. ...............................
( Here state the name of the holder of the public weighbridge licence )
........................................................................................................................
........................................................................................................................
( Here state the location of the weighbridge ) .................................................................
AXLE MASSES ONLY
Registered No. or Nos. of vehicle measured .................................................................
Name of driver of vehicle .......................................................................................
Axle No. (front to rear) | | | Kilograms | |||||
If 2 or more axles are | | | |
1 | | | | |
measured together, | | | | 2 | | | | |
this is to be shown | 3 | | | | | |||
by bracketing | | | | 4 | | | | |
the relevant axle | | | |
5 | | | | |
numbers. | | | | 6 | | | | |
.............................................................
(Signature of operator)
MASSES SHOWN ON THIS
TICKET ARE NOT TO BE
USED FOR
TRADE.