| Form E |
| (Regulations 6 and 7) |
| Application for an Inspection of an Electrical Installation |
| Date ............................................. |
| Type of inspection .......................................................................................... |
| (State whether new installation, alteration, extension, reconnection or condition) |
| Applicant's name ........................................................................................... |
| (Block Letters) |
| Owner's name ................................................................................................ |
| Owner's address ............................................................................................ |
| Address and location of installation .............................................................. |
| – | ..................................................................................................... |
| – | ..................................................................................................... |
| (Please give exact details to facilitate location of installation) |
| Nature of premises ......................................................................................... |
| (i.e. Commercial, domestic, Industrial) |
| No. of points ................................................................................................... |
| Name of wiring contractor ............................................................................ |
| Address of wiring contractor ........................................................................ |
| Wiring contractor's licence no .................................................................... |
| Wiring Contractor's Certificate |
| I certify that the whole/part of the electrical installation has been inspected and tested by me and found to be up to standard. |
| ................................................................ |
| Wiring Contractor's Signature. |
| ................................................................ |
Applicant's Signature.
|
| Date Received | Application No. | Inspection Date |
| .................................... | ..................................... | ..................................... |
| .................................... | ..................................... | ..................................... |
| .................................... | ..................................... | ..................................... |