Regulations > Electrical Machinery Regulations, 2011 > Annexures

APPLICATION FOR APPROVAL AS AN APPROVED INSPECTION AUTHORITY FOR ELECTRICAL MACHINERY

The Department of Labour

Occupational Health and Safety

Private Bag X117

Pretoria

0001

R120,00

1)	PARTICULARS OF APPLICANT

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: .................................................

2)	STATE TYPE OF REGISTRATION YOU HAVE:

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

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

3)	IN SUPPORT OF THE APPLICATION, PLEASE SUBMIT THE FOLLOWING:

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: ...........................................................................

Occupational Health and Safety Act, 1993 (Act No. 85 of 1993)