APPLICATION FOR APPROVAL AS AN APPROVED INSPECTION AUTHORITY FOR ELECTRICAL MACHINERY

The Department of Labour

Occupational Health and Safety

Private Bag X117

Pretoria

0001

SURNAME: ...................................................................................................….

FIRST NAMES: ................................................................................................….........

ID NO.: ..............................................................................................................

TRADING NAME: ..............................................................................................

State whether the business is a SOLE PROPRIETORSHIP/PARTNERSHIP/COMPANY/ CLOSE CORPORATION (delete whichever is not applicable).

BUSINESS CK NO.: .........................................................................................

PROVINCE IN WHICH BUSINESS IS SITUATED: ..........................................

PHYSICAL ADDRESS: .......................................................................................................

...........................................................................................................................

....................……............................................. POSTAL CODE: .....................

POSTAL ADDRESS: .......................................................................................................

......................................................................... POSTAL CODE: ....................

TEL NO.: ........................................ CELL. NO.: ..............................................

FAX NO.: ..........................................     EMAIL: ...............................................

SANAS REGISTRATION NUMBER: .......................................

SCOPE OF ACCREDITATION: ...............................................

1)         A certified copy of the business registration number (indicate CK No.);

2)        A certified copy of the accreditation certificate from the accreditation authority.

I hereby declare that the above particulars are, to the best of my knowledge and belief, correct.

Signature of applicant: ……………………………………. Date: ..............................

FOR OFFICE USE ONLY :

Application: APPROVED/NOT APPROVED

Reason/s for declining: .........................................................................................………................

Registration No: ...............................................………… Date: .................................