1.

(a)

Name and postal address of principal contractor:

(b)

Name and tel. no of principal contractor's contact person:

2.

Principal contractor's compensation registration number:

3.

(a)

Name and postal address of client:

(b)

Name and tel. no of client's contact person or agent:

4.

(a)

Name and postal address of designer(s) for the project:

(b)

Name and tel. no of designer(s) contact person:

5.

Name and telephone number of principal contractor's construction supervisor on site appointed in terms of regulation 8(1).

6.

Name/s of principal contractor's sub-ordinate supervisors on site appointed in terms of regulation 8(2).

7.

Exact physical address of the construction site or site office:

8.

Nature of the construction work:

9.

Expected commencement date :

10.

Expected completion date:

11.

Estimated maximum number of persons on the construction site:

Total :                                                     Male:                                            Female:                                            

12.

Planned number of contractors on the construction site accountable to principal contractor:

13.

Name(s) of contractors already selected:

Principal Contractor

                                                    Date

Client's Agent (where applicable)

                                                    Date

Client

                                                    Date