Anexo A                              Annex A                     Annexe A

                                                           (Nombre del pais)

                                                           (Name of country)

                                                             (Nomo do pais)

                                                              (Nom du pays)

                                                Certificado Internacional para Automóviles

                                                       International Automobile Certificate

                                                  Certificado Internacional para Automóveis

                                                    Certificat International Pour Automobiles

                                               (Tamaño del carnet impreso: 14.5 x 8.5 cm)

                                                 (Size of form when printed: 5 3/4" x 3 3/8")

                                            (Tamanho do modelo impresso: 14.5 x 8.5 cm)

                                              (Grandeur du format imprimé : 14.5 x 8.5 cm)

La validez de este certificado será reconocida por todas las autoridades con atribuciones para reglamentar el registro de vehículos en los países siguientes, a excepción del país que lo expida:

The validity of this certificate shall be recognized by all officials having regulatory powers over the registration of motor vehicles in the following countries, with the exception of the country in which issued:

A validez dêste certificado será reconhecida por todas as autoridades que tenham atribuições para a regulamentação do registro de veículos nos seguintes países, com exceção do país que o expedir:

La validité du présent certificat sera reconnue par toutes les autorités ayant les attributions nécessaires pour l'immatriculation des véhicules automobiles dans les pays suivants, à l'exception du pays dans lequel il est délivré:

Argentina                       Honduras
Bolivia                             México
Brasil                              Nicaragua
Colombia                       Panama
Costa nica                     Paraguay
Cuba                               Perú
Chile                               República Dominicana
Ecuador                         United States  of America                      
El Salvador                    Uruguay             
Guatemala                     Venezuela
Haiti

(Ráyense los nombres de los países que aún no hayan ratificado la Convención cuando se expida el certificado).

(Draw lines through names of countries which have not ratified the Convention at time of issue.)

(Risqueinse os nomes dos países que ainda nao tenham ratificado a Convenção até o momento da expedição do certificado.)

(Rayer les noms des pays qui n’ont pas encore ratifié la Convention au moment de la Délivrance du certificat.)

                                              INTERNATIONAL AUTOMOBILE CERTIFICATE

Issued in accordance with the provisions of the Convention on the Regulation of Inter-American Automotive Traffic signed at Washington, D. C., U. S. A., in 1943.

Issued by  _________________________________________________

At  _______________________________________________________

Date _____________________________________________________ 

Signature (*) _______________________________________________

Number ___________________________________________________

  
(*) Signature of Authority or signature of Association empowered by the Authority, and “visa” of the latter.

Good for one year from date of issue.

                                      Surname: __________________________________

Owner or Holder        Other names:________________________________

                                      Home address:______________________________

Class of vehicle: ______________________________________________ 

Name of maker of chassis: ______________________________________  

Type of chassis: ______________________________________________

Serial number of typo or maker’s number of chassis:__________________

                     Number of cylinders: ________________________________

                     Engine number: ____________________________________

Engine        Stroke: ___________________________________________

                     Bore: ____________________________________________

                     Horse power:_______________________________________

                     Type:_____________________________________________

Body           Color: _____________________________________________

                     Number of seats:____________________________________

Weight of vehicle without load (in kilos):______________________________ 

Weight of vehicle fully loaded (in kilos) if exceeding 3,500 kilos:___________

Identification marks on plates:______________________________________

                                                     VISA DE ENTRADA

                                                       ENTRANCE VISA

                                                     VISTO DA ENTRADA

                                                        VISA D'ENTRÉE

(La visa de entrada debe contener los siguientes datos: país, lugar, fecha, firma y sello de la autoridad que otorga la visa.)

(The entrance visa should contain the following data: country, place, date, signature and seal of the authority granting the visa.)

(O visto de entrada deverá conter os seguintes dados: país, lugar data, assinatura e sêlo da autoridade que deu o visto).

(Le visa d’entree doit contenir les données suivantes: pays, lieu, date, signature et sceau de l’autorité qui accorde le visa.)