APPLICATION FOR REGISTRATION AS AN ELECTRIC FENCE SYSTEM INSTALLER

The Department of Labour

Occupational Health and Safety

Private Bag X117

Pretoria

0001

Surname (block letters): ............................................................………………………

First names (block letters): ......................................................................................……………………….

Postal address: .......................................................................................................................

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

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

Code: ...........…

Telephone Nos.: (W) ............................. (H)  ...................................

(Fax) ............................(Cell) ................................

Date of birth: ........................... Place of birth:  ................................

Identity number (immigration permit number): .................................

A certified copy of electric fence system installer proficiency must be attached.

Two clear identical unmounted photographs of 40 mm by 30 mm showing the face and shoulders of the applicant to be submitted. One photograph to be certified on the back as follows:

I certify this to be a true photograph of.........................................…………………….

…………………………………………….………                                            .......……………………………

Signature of Magistrate, Justice of the                                  Date

Peace or Commissioner of Oaths

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

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

SPECIMEN SIGNATURE OF APPLICANT

Note - The specimen signatures should be the normal signature of the applicant and should be carefully completed. One specimen will be affixed to any certificate of registration that may be issued.

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