Lifting Machine Entity Registration - Ion
Lifting Machine Entity Registration - Ion
NAME OF CEO/MD/MEMBER
CONTACT PERSON
Postal Address
Signature Designation
Physical Address
Cell No
Section 2 to be completed by Lifting machine inspector staff directly responsible for the testing of lifting machines 2.a Personal Detail First Names:
Surname:
Date of Birth:
Identity No:
Nationality:
Position held:
ECSA REGISTRATION
LMI No.:
Employer
Post Held
Date obtained
Educational Institution
I, (full names) hereby accept the nomination as a Lifting Machine Inspector for this company. I solemnly declare that, to the best of my knowledge, all the information contained herein is true. Name Date : 3. EQUIPMENT: a. b. c. d. e. f. 'Signature:
4. SCOPE OF APPLICATION a. b. c. d. e. f.
5. ADDITIONAL INFORMATION REQUIRED 5.a. Certified copies of qualifications 5.b. Calibration certificate of testing equipments and instruments 5.c. Copy of test certificate for each type of lifting equipment 5.e. Summary of the auditable system of work performed 5.f. Copy of training program for technical staff 5.d. Copy of a company code of conduct for Technical staff in relation to OSHACT
5.g. Summary of inspection method for each type of lifting equipment including relevant national standards 3. DECLARATION BY MANAGING DIRECTOR / MEMBER OF ENTITY
I, .. (full names) hereby apply for registration of .... (Company) as a Lifting Machine Entity. I solemnly declare that, to the best of my knowledge, all the information contained herein is true. 'Signature: Sworn to / Affirmed before me at on this the day of Commissioner of Oaths / Justice of Peace: (month and year) (Commissioner's stamp)
Please Post your application form to: Chief Inspector,Department of Labour Private Bag x 117 PRETORIA 0001. Laboria Hoouse,215 Schoeman Street, Pretoria 0001