Section 6: Final fire safety certificate declaration I, (insert full name) being the (mark applicable box) owner owner’s agent certify that each essential fire safety measure specified in this certificate: a) has been assessed by a properly qualified person, and b) was found, when it was assessed, to be capable of performing to at least the standard required by the current fire safety schedule for the building for which this certificate is issued. Owner/Agent Name Owner/Agent Signature Date Section 7: Interim fire safety certificate declaration I, (insert full name) being the (mark applicable box) owner owner’s agent certify that each essential fire safety measure specified in this certificate: a) has been assessed by a properly qualified person, and b) was found, when it was assessed, to be capable of performing to at least the standard required by the current fire safety schedule for the part of the building to which this certificate relates. Owner/Agent Name Owner/Agent Signature Date Section 8: Owner’s authorisation (To be completed where an agent makes the declaration in Section 6 or Section 7 of this form) I, being the owner, authorise the agent named in Section 6 or Section 7 to act on my behalf to make the declaration. Name Date Owner’s Owner’s Signature Section 9: Contact details of person issuing this certificate Title Given Name/s Family Name Phone Email Section 10: Fire safety schedule A current fire safety schedule for the building must be attached to this certificate.
Section 6: Final fire safety certificate declaration I, (insert full name) being the (mark applicable box) owner owner’s agent certify that each essential fire safety measure specified in this certificate: a) has been assessed by a properly qualified person, and b) was found, when it was assessed, to be capable of performing to at least the standard required by the current fire safety schedule for the building for which this certificate is issued. Owner/Agent Name Owner/Agent Signature Date Section 7: Interim fire safety certificate declaration I, (insert full name) being the (mark applicable box) owner owner’s agent certify that each essential fire safety measure specified in this certificate: a) has been assessed by a properly qualified person, and b) was found, when it was assessed, to be capable of performing to at least the standard required by the current fire safety schedule for the part of the building to which this certificate relates. Owner/Agent Name Owner/Agent Signature Date Section 8: Owner’s authorisation (To be completed where an agent makes the declaration in Section 6 or Section 7 of this form) I, being the owner, authorise the agent named in Section 6 or Section 7 to act on my behalf to make the declaration. Owner’s Name Owner’s Signature Date Section 9: Contact details of person issuing this certificate Title Given Name/s Family Name Phone Email Section 10: Fire safety schedule A current fire safety schedule for the building must be attached to this certificate.
fire-safety-certificate-form.docx