CERTIFICATE OF CONFORMITY FOR GAS INSTALLATIONS

OCCUPATIONAL HEALTH AND SAFETY ACT, 1993

Regulation 17(3) of the Pressure Equipment Regulations, 2009

Certificate of conformity by an authorised person

I, _______________________________, declare that I am an authorised person for gas installations with registration number _____________ and ID number __________

Address __________________________________

_________________________________________

_________________________________________

Telephone number (______) __________________

I further declare that I inspected and tested the installation at -

Street ___________________________________

Stand number _____________________________

Name of building ___________________________

Name of farm _____________________________

Number of farm ___________________________

Township/Municipality/District ________________

Name of gas supplier ______________________

Type of gas ______________________________

Amount of gas stored on premises ___________kg

and that, in terms of regulation 17(3), the installation complies with the provisions of 17(2) and that the installation is safe.

I am aware that I am liable to prosecution in the case of a false declaration.

________________                                                          __________________

Signature                                                                            Date