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CUSTOMER ID*

IFSP S/N*

COMPANY*

BUILDING NAME (LOCATION MFAP)*

ADDRESS*

STATE*

POSTCODE*

COMPANY REGISTRATION NO*

FIXED LINE (OFFICE 24 HRS)*

FIRE CERTIFICATE (FC)*

YES

DATE FC*

NAME*

MOBILE NUMBER*

EMAIL*

POSITION*

NAME*

MOBILE NUMBER*

EMAIL*

POSITION*

DO YOU KEEP ANY HAZARDOUS MATERIALS IN BUILDING?*

YES

LIST OF HAZARDOUS AREA/ROOM IN BUILDING*

HAZARDOUS MATERIALS*

NAME*

MOBILE NUMBER*

EMAIL*

POSITION*

DATE*

CHANGE OF SPKA PORTAL REGISTERED DETAILS

CUSTOMER ID:

IFSP S/N:

COMPANY:

BUILDING NAME (LOCATION MFAP):

ADDRESS:

STATE:

POSTCODE:

COMPANY REGISTRATION NO.:

FIXED LINE (OFFICE 24 HRS):

FIRE CERTIFICATE:

DATE FC:

NEW REGISTERED PERSON-IN-CHARGE 1

NAME:

MOBILE NUMBER:

EMAIL:

POSITION:

NEW REGISTERED PERSON-IN-CHARGE 2

NAME:

MOBILE NUMBER:

EMAIL:

POSITION:

Do you keep any hazardous materials in the building?:

LIST OF HAZARDOUS AREA/ROOM IN THE BUILDING:

HAZARDOUS MATERIALS:

CUSTOMER DECLARATION

I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately.

NAME:

MOBILE NUMBER:

EMAIL:

POSITION:

DATE:

CHANGE OF SPKA PORTAL REGISTERED DETAILS

NEW REGISTERED PERSON-IN-CHARGE 1 *

NEW REGISTERED PERSON-IN-CHARGE 2 *

CUSTOMER DECLARATION*