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.