FORM WSIA/PDCI4 WATER SERVICES INDUSTRY ACT 2008 WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM AND SEPTIC TANK) RULES 2013 DETAILS FOR ELECTRICAL DESIGN AND DRAWINGS Date: 20 To: Sewerage Certifying Agency | horeby declare in accordance with the Statutory Declaration Act 1960 that the details in the design and drawings for ‘electrical works for the stated sewerage works: ‘on address! lot(): ‘are compiete, true and accurate. hereby further declare that the electrical works have been designed by me in accordance with sound engineering practice, approved design, Malaysian Sewerage Indusiry Guidelines and Standards and that | take full responsibilty for the design and performance of the same ‘Signature of Competent Person Name of Competent Person (in block letters) LONo, Address “Telephone No. Fax No E-mail address FOR OFFICIAL USE ONLY Reference No,