Gas Act, 2001 (Act No. 48 of 2001)Rules in terms of the Gas Act, 2001AnnexuresAnnexure E : Form: Application for an amendment of a licenceSection E: Solemn Declaration by Applicant / Mandated Representative |
I (full names) ...........................................................................................Identity Number ................................................hereby declare that:
| (a) | I am authorised by ............................................................................................................................to make this declaration (attach the authorisation); and |
| (b) | All information provided herein is within my personal knowledge and is both true and correct. |
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Signature
I certify that the deponent:
| (a) | has acknowledged that she/he knows and understands the contents of this application form and its annexures, that she/he has no objection to taking the prescribed oath and that she/he considers the oath binding on her/his conscience; and |
| (b) | has in the prescribed manner sworn that the contents of this application form and its annexures are true and signed same before me at ...................................................................(place) on this.....................day of...................................(month) ...............................(year). |
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COMMISSIONER OF OATHS
Name ______________________________________________________________________
Address ______________________________________________________________________
Capacity ______________________________________________________________________