1-Customer Registration FormSHELL CUSTOMER REGISTRATION FORM FOR
SHELL E-BOXESECOTAX and French, Spanish, Portugal and Liefkenshoek
tunnel e-Toll SystemCountry code :050102To order your e-boxes for
Shell InterRoute Plus, please :03- Complete this Customer
Registration Form and the e-Boxes Order04- Complete and scan the
mandate05- Scan (pdf format) the certificate of incorporation of
the company06- Scan (pdf format) the vehicle registration document
of vehicles you want to order e-boxes07For more information on
documents to be collected to activate ITR+ e-box, please read the
tab "Documents collection".08Send it back via email :09Sign, date
and add your company stamp to the Appendix and send it back to us
:1011If you need assistance, please contact us at the following
number : or by e-mail:1213Company Name (legal entity)euroShell
Customer nr14(8 digits)15VAT registration nror EORI number16Type of
customer17Delivery address for e-boxes181 address per euroShell
Card Customer number19ZIP CODECITY20COUNTRY (Use the drop down
menu)21Title of contact Person (Use the drop down menu)Position (of
contact person)22First Name (of contact person)Last Name (of
contact person)23Office Phone number (without country code and area
code)24e-mail address of the contact person25Average monthly spend
on French Motorway TollsGBPOREURO2627This is my first order for
InterRoute Plus e-toll box with Shell28This is NOT my first order
for InterRoute Plus e-toll box with Shell293032Company Stamp :Date
:01/02/1433Signature :34Signee Name :35363738394041Vehicle Country
CodeTitle42ALBANIAALM43ANDORRAADMME44AUSTRIAAT45BLARUSBY46BELGIUMBE47BOSNIABA48BULGARIABG49CROATIAHR50CYPRUSCYCZECH
REPUBLICCZDENMARKDKESTONIAEEFINLANDFIFRANCEFRGERMANYDEGREECEGRHUNGARYHUIRELANDIEITALYITLATVIALVLITUANIALTLUXEMBURGLUMACDOINEMKMOLDOVIAMDNETHERLANDSNLNORWAYNOPOLANDPLPORTUGALPTROMANIARORUSSIARUSERBIARSSLOVAKIASKSLOVENIASISPAINESSWEDENSESWITZERLANDCHTURKEYTRUKRANIAUAUNITED
KINGDOMGB
&C&9 Registered in England and WalesCompany
Registration. Number: 3625633Registered office: Shell Centre,
London, SE1 7NABy signing this document, you recognize that you
read, understood and accepted the Appendix Shell InterRoute joined
to the present document or consultable on our website
www.euroshell.com. In order for us to send you the e-boxes, you'll
need to return to the Shell address written on top of this document
the Appendix signed and stamped.12
2-e-Boxes OrderSHELL CUSTOMER REGISTRATION FORM FOR SHELL
E-BOXESECOTAX and French, Spanish, Portugal and Liefkenshoek tunnel
e-Toll SystemNr of badgesContract informationRedevable
informationCard informationVehicle informationDelivery
AddressRenting Company
informationMandatoryMandatoryMandatoryIgnoreAutomatically
filledAutomatically filledAutomatically filledAutomatically
filledAutomatically filledAutomatically filledAutomatically
filledAutomatically filledAutomatically filledAutomatically
filledAutomatically filledAutomatically
filledMandatoryMandatoryMandatoryMandatoryMandatoryOptionalMandatoryMandatoryMandatoryMandatoryMandatoryMandatoryMandatoryOptional
: have to be filled if the badges have to be delivered to another
addressOptional (Mandatory if Owner of the vehicle =
'R')MandatoryUrgent Order (only if necessary, can be extra
fees)Offer codeType of EquipementOrdering countryVehicle
CountryVehicle License PlateMin Number of Axles TruckMin Number of
Axles TrailerVehicle Registration Date (dd/MM/yyyy)Vehicle
EmissionEEVGross Vehicle Weight RatingAuthorized Gross Vehicle
WeightEuropean Vehicle CategoryVehicle TypeOwner of the
vehicleDelivery ContactTitleDelivery Contact LastNameDelivery
Contact FirstNameDelivery ContactStreetDelivery ContactAddres
ComplementDelivery ContactZIPDelivery ContactCityDelivery
ContactCountryRenting Company NameRenting Company SteetZip Code
Renting CompanyCity Renting CompanyCountry Renting CompanyVAT ID
Renting CompanySIRET number Renting CompanyEORI number Renting
CompanyUse the drop down menu.Customer No Siras account number 10
digitsCompany Name40 digitsCustomer Address Streetname38
digitsCustomer Address ComplementCustomer ZIP CodeCustomer
CityCustomer CountryEmail For Internet Account CreationContact
TitleContact FirstNameContact LastNameCustomer VAT IDSIRET
numberEORI numberCard NumberUse the drop down menu.For further
information, please refer below to the table named "Vehicle
category"As indicated on the vehicle certificate (with or without
spaces and or dash)Our advice is to indicate 2 by default. This
data will be used for the set up of the badge.Our advice is to
indicate 3 by default. This data will be used for the set up of the
badge.Exact date on the vehicle certificate or leave it blankUse
the drop down menuUse the drop down menuField F2 of the vehicle
certificate or field F1 if F2 is blankField F3 of the vehicle
certificate. If blank, please indicate the same weight than in
field "Gross Vehicle Weight Rating"Use the drop down menu. For
further information, please refer below to the table named "Vehicle
category"Use the drop down menu :
HGV = TruckLGV = Tis VL onlyUse the drop down menu :
C = You are the ownerR = Vehicle is rentedUse the drop down
menuUse the drop down menuUse the drop down menu1ECOTAX + TISPL +
ITR05000000000000BAA78-J-75123Euro
5No2010020100N3HGVCTISPLAL2ECOTAX + TISPL +
ITR05000000000000BAT64-T-68823Euro
5No1800018000N3HGVCInterRouteAD3ECOTAX + TISPL +
ITR05000000000000BAA05-T-73523Euro
5No1800018000N3HGVCTISVLAT4ECOTAX + TISPL +
ITR05000000000000BA403-J-47823Euro 5No1800018000N3HGVCECOTAX +
TISPLBA5ECOTAX + TISPL + ITR05000000000000BAO28-T-35223Euro
5No1800018000N3HGVCECOTAX + TISPL + ITRBE6ECOTAX + TISPL +
ITR05000000000000BA943-T-37423Euro 5No1900019000N3HGVCBG7ECOTAX +
TISPL + ITR05000000000000BAO28-T-35323Euro
5No1800018000N3HGVCBY8ECOTAX + TISPL +
ITR05000000000000BAE09-T-01123Euro 5No1800018000N3HGVCCH9ECOTAX +
TISPL + ITR05000000000000BAT42-M-63823Euro
5No1800018000N3HGVCCY10ECOTAX + TISPL +
ITR05000000000000BAJ81-O-19623Euro 5No1800018000N3HGVCCZ11ECOTAX +
TISPL + ITR05000000000000BAA03-K-88423Euro
5No1800018000N3HGVCDE12ECOTAX + TISPL +
ITR05000000000000BAM81-J-16823Euro 5Yes1800018000N3HGVCDK13ECOTAX +
TISPL + ITR05000000000000BAK67-E-00423Euro
5No1800018000N3HGVCEE140000000000000ES150000000000000FI160000000000000FR170000000000000GB180000000000000GR190000000000000HR200000000000000HU210000000000000IE220000000000000IT230000000000000LT240000000000000LU250000000000000LV260000000000000MD270000000000000MK280000000000000NL290000000000000NO300000000000000PL310000000000000PT320000000000000RO330000000000000RS340000000000000RU350000000000000SE360000000000000SI370000000000000SK380000000000000TR390000000000000UA40000000000000041000000000000042000000000000043000000000000044000000000000045000000000000046000000000000047000000000000048000000000000049000000000000050000000000000051000000000000052000000000000053000000000000054000000000000055000000000000056000000000000057000000000000058000000000000059000000000000060000000000000061000000000000062000000000000063000000000000064000000000000065000000000000066000000000000067000000000000068000000000000069000000000000070000000000000071000000000000072000000000000073000000000000074000000000000075000000000000076000000000000077000000000000078000000000000079000000000000080000000000000081000000000000082000000000000083000000000000084000000000000085000000000000086000000000000087000000000000088000000000000089000000000000090000000000000091000000000000092000000000000093000000000000094000000000000095000000000000096000000000000097000000000000098000000000000099000000000000010000000000000001010000000000000102000000000000010300000000000001040000000000000105000000000000010600000000000001070000000000000108000000000000010900000000000001100000000000000111000000000000011200000000000001130000000000000114000000000000011500000000000001160000000000000117000000000000011800000000000001190000000000000120000000000000012100000000000001220000000000000123000000000000012400000000000001250000000000000126000000000000012700000000000001280000000000000129000000000000013000000000000001310000000000000132000000000000013300000000000001340000000000000135000000000000013600000000000001370000000000000138000000000000013900000000000001400000000000000141000000000000014200000000000001430000000000000144000000000000014500000000000001460000000000000147000000000000014800000000000001490000000000000150000000000000015100000000000001520000000000000153000000000000015400000000000001550000000000000156000000000000015700000000000001580000000000000159000000000000016000000000000001610000000000000162000000000000016300000000000001640000000000000165000000000000016600000000000001670000000000000168000000000000016900000000000001700000000000000171000000000000017200000000000001730000000000000174000000000000017500000000000001760000000000000177000000000000017800000000000001790000000000000180000000000000018100000000000001820000000000000183000000000000018400000000000001850000000000000186000000000000018700000000000001880000000000000189000000000000019000000000000001910000000000000192000000000000019300000000000001940000000000000195000000000000019600000000000001970000000000000198000000000000019900000000000002000000000000000
3-MandateTAXE POIDS LOURDSMANDAT POUR LA DECLARATION DU VEHICULE
ET LE PAIEMENT DE LA TAXEEntreprise (raison sociale, adresse) :Je
soussign (NOM, Prnom) :Agissant en qualit de :0dument habilit(e)
aux fins des prsentesDonne par la prsente, mandat AXXES SAS situe
Tour Oxygne, 10-12 bd Vivier Merle, 69393 LYON CEDEX 03 France,
agissant en qualit de Socit Habilit de Tlpage
Pour dclarer mon (mes) vhicule(s) lenregistrement pour mon
compte et me dsigner comme redevable enregistr ainsi que pour
acquitter la taxe due au titre de la taxe poids lourds en mon nom
et pour mon compte.
Jatteste avoir fourni AXXES SAS, des pices justificatives
valides afin de procder lenregistrement de mon (mes) vhicule(s).
Ainsi je me porte garant de lexactitude et de la vracit des dites
pices au regard de la rglementation applicable.
Je dclare ne pas tre li contractuellement auprs dune socit
tierce pour les services cits ci-dessus, ou, le cas chant, avoir
effectu toutes les oprations de rsiliation pour tout autre contrat
dabonnement contract pour ces services auprs dune socit tierce.
Je souhaite recevoir les dtails de liquidation et donne, par la
prsente, mandat Axxs pour solliciter en mon nom et pour mon compte
les dtails de liquidation.Liste des vhicules concerns par le prsent
mandatQualit du signataire (ou de la socit reprsente par le
signataire) au regard du (des) vhicule(s)Genre NationalN
IMMATRICULATIONPAYS
DIMMATRICULATIONPropri-taireLoca-taireSous-locataireUtilisa-teur1NDA78-J-7510X02NDT64-T-6880X03NDA05-T-7350X04ND403-J-4780X05NDO28-T-3520X06ND943-T-3740X07NDO28-T-3530X08NDE09-T-0110X09NDT42-M-6380X010NDJ81-O-1960X011NDA03-K-8840X012NDM81-J-1680X013NDK67-E-0040X014ND0015ND00Fait
, le01/02/14Faire prcder la signature de la mention Bon pour
mandat, et apposer le cachet de lentrepriseAxxs SAS au capital de
7.500.000,00 Euros Tour oxygne 10-12 Bd Vivier Merle 69393 LYON
CEDEX 03 RCS Lyon 482 930 385 N TVA : FR40482930385For information
only, do not fill in the English versionHEAVY GOOD VEHICLES
TAXMANDATE FOR THE REGISTRATION OF VEHICLES AND PAYMENT OF THE
TAXCompany name and address:I the undersigned [Last name, First
name] :Acting as :duly authorized for the purpose of this
mandateGrants by this letter, mandate to AXXES SAS located Tour
Oxygne, 10-12 bd Vivier Merle, 69393 LYON CEDEX 03 France, acting
as SHT (Socit Habilit de Tlpage Approved Electronic Toll
Company)
To declare my vehicle(s) for registration on my behalf and
nominate me as the liable registered person as well as paying the
tax applicable to the heavy good vehicles in my name and for my
account.
I hereby confirm that I have given to AXXES SAS, valid
supporting documents in order to proceed registration of my
vehicle(s). Thereby, I am answerable for the accuracy and veracity
of the documents in light of the applicable regulation.
I declare not being contractually bound to a third party
supplier for the above described services, or, if required, having
conducted all necessary actions for the termination of any other
subscription contract taken for the above services to a third party
supplier.
I wish to receive the detail of tax assessments and give, by
this letter, mandate to AXXES SAS, to obtain on my behalf and my
account the assessment details.List of vehicle affected by the
present mandateDescription of the signatory (or the company
represented by the signatory) in view of the vehicles(s)National
GenderVehicle Registration Number (VRN)Vehicle Registration
CountryOwnerRenteeSub renteeUserDone at . on . / . / .Before the
signature, please hand-write Bon pour mandat , and stamp it with
the stamp of your companyAxxs SAS au capital de 7.500.000,00 Euros
Tour oxygne 10-12 Bd Vivier Merle 69393 LYON CEDEX 03 RCS Lyon 482
930 385 N TVA : FR40482930385
Documents collectionObject >>Redevable /
beholdenVehicleRedevable categoryRedevable / beholden
(by default, for Ecomouv, the beholden Is the name on the
vehicle registration certificate)Certificate of
incorporationMandateVehicle registration certificateCertificate of
conformity (COC)CEMT authorizationManufacturer
certificateLeasing/rental contractOutsourcing contractCompanyOwner
orLeased vehicle (for less than 3
months)MandatoryMandatoryMandatory- If no proof document for axle:
number of axle will be considered as "4 and +" by Ecomouv.
- If no proof document for EURO class: Ecomouv' will use the
most unfavourable Euro class.Tenant of the vehicle (for more than 3
months)orSub-tenant (for more than 3
months)MandatoryUserMandatoryAdditionalinformationAT proof, EORI
proof, proof of company registration to the chamber of commerce or
proof of association creationOut of UE: At least one of this 3
documents must be provided with the Vehicle registration
certificate.Mandatory if name of the company is not the one
mentioned on Vehicle registration certificate.Mandatory if name of
the company is not the one mentioned on Vehicle registration
certificate.Please find some recommendations to transfer documents
:- You remain responsible of documents until they come to Shell-
Always use a encrypted format using WINZIP, before sending it to
Shell- Whatever is the sending format (email, USB key, CDROM), send
password separately from the winzip fileSee below the process
:Sending a ZIP file with encryptionStore the file on a location.Go
to the location and right click on the file.Chose the option Send
to -> Compressed (zipped) FolderA Zip file will be created with
the same name as the original file.Open the Zip file by double
clicking:Choose the option Encrypt in the menu icons:Below screen
will appear that allows you to enter a password (2x)Please ensure
the encryption type is set to 256-Bit AES encryption:Click on OKThe
file name will now show it is encrypted as the file has a *
Example.txt*The Zip file can now be attached to an e-mail and send
to the receiver.
Vehicle categoryType of vehicle
codeDefinitionCommentsAOtherLMotor vehicles with two or three-wheel
and four motorM1Vehicles designed and constructed for carrying 9
passengers included the driverCoach companies are not liable for
EcotaxM2Vehicles designed and constructed for carrying more than 9
passengers included the driver and having a maximum mass not
exceeding 5 tonnesM3Vehicles designed and constructed for carrying
more than 9 passengers included the driver and having a maximum
mass exceeding 5 tonnesN1Vehicles designed and constructed for the
transport of goods and having a maximum mass not exceeding 3,5
tonnes.N2Vehicles designed and constructed for the transport of
goods and having a maximum mass between 3,5 and 12
tonnes.N3Vehicles designed and constructed for the transport of
goods and having a maximum mass exceeding 12 tonnes.INot
knownVehicle Country
CodeALBANIAALANDORRAADAUSTRIAATBLARUSBYBELGIUMBEBOSNIABABULGARIABGCROATIAHRCYPRUSCYCZECH
REPUBLICCZDENMARKDKESTONIAEEFINLANDFIFRANCEFRGERMANYDEGREECEGRHUNGARYHUIRELANDIEITALYITLATVIALVLITUANIALTLUXEMBURGLUMACDOINEMKMOLDOVIAMDNETHERLANDSNLNORWAYNOPOLANDPLPORTUGALPTROMANIARORUSSIARUSERBIARSSLOVAKIASKSLOVENIASISPAINESSWEDENSESWITZERLANDCHTURKEYTRUKRANIAUAUNITED
KINGDOMGB