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

Regulations

Electrical Machinery Regulations, 2011

Annexures

Annexure 3 : Regulation 17(1) of the Electrical Machinery Regulations

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