FORM 1

APPLICATION TO ENTER INTO CONTRACT

(Regulation 3(2))

I, __________________________________________________________________________(full names and surname) on behalf of ..............................................................................(organisation's name and NOP number), here by apply to enter into a contract referred to in section 7(1)(c) of the Act.    I provide the following services to (number) _____________________________________ persons (see attached list) at (physical address)

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I declare that the above information is true and correct. I understand that any misrepresentation or omission of  pertinent  information may be considered as sufficient grounds for rejecting the application.

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Signature of applicant                                                                                      

Place  _________________________________  Date ______________

Documents to be attached to the form