| (Regulation 9) |
| THE PRIVATE HOSPITALS ACT |
| Licence to operate a Private Hospital |
| No. ............................. |
| Under the Private Hospitals Act and regulations subject to the limitations thereof this licence is issued to ............................................................................ to operate a private hospital for ............................................................................. |
| (described services) |
| ................................................................................................................... |
| (which may be performed) |
for the treatment of not more than ....................................................................
............................................... patients at any one time at ...............................
.............................................................................................................. |
| This licence expires on 31 December ............................................................. |
| Date of issue...................................................................20........... |
| .......................................... |
| Minister of Health. |