CERTIFICATE BY EMPLOYER (if any)

Occupation of employee (applicant)        .......................................................................................

Full work address of employee (applicant)        ...........................................................................

I, ........................................................... in my capacity ................................................ as have no objection that .................................................................................. become a member of the Fire Brigade Reserve Force and that he be summoned during office hours in an emergency.

..................................................                        .................................................

Signature of employer                                         Office Stamp

Date .........................................

I, the undersigned, solemnly and sincerely commit myself herewith, as long as I am a member of the Fire Brigade Reserve Force of ................................................................................................................. to render the service referred to in my application above to the best of my ability and without fear or contradiction and to undergo training in connection therewith, in terms of the Fire Brigade Services Act, 1987 (Act No. 99 of 1987), and the Regulations promulgated in terms thereof.

I am satisfied with the disability insurance that the controlling authority has taken out on my behalf.

..................................................                        .................................................

Signature of applicant                                        Date

The applicant undertook and signed this commitment on ............................................................................ before me after he/she acknowledged that he/she knows and understands the contents thereof.

.....................................................

Chief Fire Officer

PERMISSION OF PARENT OR GUARDIAN (To be completed in the case of a minor)

I, the undersigned, being the parent/lawful guardian of ...................................................................................... agree to the abovementioned commitment.

..................................................                        .................................................

Signature of applicant                                        Date