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[FORM No. 3A

[See Rule 12 (3)] NOTICE OF CHANGE OF MANAGER 1. (a) Name of the Factory (b) Factory Licence number 2. 3. 4. Postal address of the Factory Name of outgoing Manager (a) Name of new Manager (b) Residential address (c) Telephone numbers: Office Residence 5. 6. : : : : : : : :

Date of appointment of new Manager : Signature of new Manager and Date :

SIGNATURE OF OCCUPIER Date: (NAME IN BLOCK LETTERS)

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