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Gas Act, 2001 (Act No. 48 of 2001)

Rules in terms of the Gas Act, 2001

Annexures

Annexure F : Form: Application for the revocation of a licence

Section C: Solemn declaration by the person willing and able to assume the rights and obligations of the Licensee or 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 relating to .................................................................................................................provided herein is within my personal knowledge and is both true and correct.
(c) ......................................................................................................................is willing and able to assume the rights and obligations of the licensee in accordance with the requirements and objectives of the Act; and
(d) .......................................................................................................................will apply for the relevant licence.

 

 

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

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).

 

 

____________________________________________________

COMMISSIONER OF OATHS

 

Name          ______________________________________________________________________

 

Address      ______________________________________________________________________

 

Capacity     ______________________________________________________________________