Cert
System
New Certificate
New Certificate
A
Owner / Manager of Premises
Full Name
*
B
Business Address
Street Name
PO Box
*
C
Plot Number
ERF No.
*
D
Trade Name of Premises
Trade Name
*
E
Class Business / Trade
Select all that apply
*
CONSTRUCTION SERVICES
CLEANING SERVICES
MEDICAL SUPPLIES
RETAIL
FOOD & BEVERAGES
TRANSPORT SERVICES
ELECTRICAL SERVICES
PLUMBING SERVICES
SECURITY SERVICES
OTHER
Add custom type (one per line, will be appended):
F
Class Building & Conditions
Class Building (optional)
Conditions
Certificate Details
Valid Until
*
Health Officer Signed Date
CEO Signed Date
Receipt No.
Create Certificate
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