[Certificate to be typed on Manufacturers Headed

Paper]

CERTIFICATE OF INSTALLATION OF MECHANICAL/ELECTRICAL

EQUIPMENT

(This section to be completed by supplier company.)

We the above named company certify that (name of person carrying out installation) has
been trained in the installation of (equipment type) and is hereby certified as
competent to install the named equipment.
Models: ___________________________________________________________
The training was carried out at (location of training) on the dates listed and the named
person has been issued with a certificate of competency.
Dates of training
Signed: ________________________ (Training Instructor)

Date: ________________________

Company stamp

(This section to be completed by person performing installation.)

Is there an “ETCI completion certificate” and a “Supplementary Agricultural
Certification Form” completed for the electrical isolator to which the electrical
connection was made during installation of the above equipment?

I confirm that I installed (Manufacturer’s name, product name and model number)
Name of Client: _____________________________________________

Address: _____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

The installation took place on: _________________________________

Signed: _______________________ (Person performing installation, as named above.)

Date: _______________________