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GAS FITTING/GAS APPUANCE / GAS EQUIPMENT

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No.:

FIRST SCHEDULE (Subregulation 117(2))

FORM K

GOVERNMENT OF MALAYSIA GAS SUPPLY ACT 1993

CERTIFICATE OF APPROVAL

GAS FITTING/GAS APPUANCE / GAS EQUIPMENT

I n a c c o r d a n c e w i t h s u b r e g u l a t i o n 1 1 7 ( 2 ) o f t h e G a s S u p p l y R e g u l a t i o n s 1 9 9 7 , I hereby approve the following item for sale and use:

Description of gas fitting/gas appliance/gas equipment*:

Trade Name:………

Type/Model: ………

KW rating: ………...

This approval is issued to: ………

... ………

.... ………...

(Name., I/C No and Address of Holder)

on behalf of. ………

(Company)

Place of issue/renewal* : ……….

Date of issue/renewal* : ...

Approval No. : ……….

Fee : RM ………...

Holder's Signature ………

or thumbprint Director General of Gas Supply Malaysia

Note:

I f t h i s C e r t i f i c a t e . c o m e s i n t o t h e p o s s e s s i o n o f a n y p e r s o n o t h e r t h a n t h e p e r s o n to whom it was issued, it shall be returned immediately to the Director General of Gas Supply, Malaysia.

*Delete whichever is not applicable.

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