Statistics Act, 1999
R 385
Gas Act, 2001 (Act No. 48 of 2001)Rules in terms of the Gas Act, 2001AnnexuresAnnexure F : Form: Application for the revocation of a licenceSection 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. |
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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). |
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COMMISSIONER OF OATHS
Name ______________________________________________________________________
Address ______________________________________________________________________
Capacity ______________________________________________________________________
