TPM Authorisation Form

Company Name *

Company ABN *

Mechanics Name *

First

Last

Authorisation *

I confirm I am requesting a Third Party Maintenance (TPM) code to disable the interlock device in order to complete work on above mentioned vehicle. I agree to be responsible for the TPM code and understand that it is not to be issued to the client at any point. Once work as described above is completed, I am to ensure the interlock is in working condition and interlock override has been exited (press *#0), vehicle engine is off and unable to be turned on without a breath test by the client or their representative before the vehicle is returned to the client. I understand that jump starting the vehicle will cause a violation on the clients program and may damage the interlock for which I will be liable. I understand that I may face legal penalties if the participant is found driving without an active interlock device as a result of me not exiting the override prior to returning the vehicle to the client.

Clients Name *

First

Last

Vehicle Registration Plate *

Vehicle Type (Make, Model) *

Number of Days code required for *

Please note code lasts for 8 hours. A new code needs to be issued each day – Mechanic (as identified on this form) needs to contact Guardian each day with Call Code from the handset (press #1 to retrieve) to be issued code.

The work on the vehicle involves: (insert brief description, e.g. body work, replacing alternator, etc.) *

Call Code – To retrieve the Call Code power up the vehicle, once the head unit has loaded press #5. *

If you do not have access to the vehicle yet please ask the participant to obtain this code for you. This form cannot be submitted without this code entered.