BC Statutory Declaration Registration of Fittings Form 1124

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STATUTORY DECLARATION REGISTRATION OF FITTINGS
(a) Design Qualification I,
(See Note 1)
,
(Position e.g., president, plant manager, chief engineer)
of
(Name of company)
located at
(Plant address)
do solemnly declare that the fittings listed hereunder comply with all the: requirements of the ANSI/ASME codes are required; OR
(detail specific code)
as to their dimensions, material, identification and service for which they
are not covered by the provisions of the ANSI/ASME codes, and are therefore constructed to comply with standard, and are designed to the best current engineering practise, as shown by the supporting calculations and test data.
code or
(b) Quality Control of Manufacture I further declare the manufacture of these fittings is controlled by a quality control program which complies with the requirements of , and has been verified by the following authority or Authorized Inspection Agency:
(Authority or AIA) (detail specific code)
The fittings covered by this declaration for which I seek registration are
(List all fittings and models on separate sheet if necessary)
In support of the application, the following information, calculations and/or test data are attached:
Declared before me at
in the
of
the
day of
AD
Commissioner for Oaths
Signature of Declarer
FOR OFFICIAL USE ONLY The application is accepted for registration in Category in accordance with CSA Standard B51.
This registration must be revalidated after ten (10) years from the date of acceptance. Registered Number CRN For the Chief Inspector Date:
Notes: 1. This form shall be completed and signed by the President or highest official in the manufacturing plant where the fitting is produced. 2. One completed original of the Statutory Declaration form together with one copy of Catalogues, drawings or bulletins illustrating above fittings shall be submitted. 3. All fittings are required to be registered in the Name of the Manufacturer.
FRM-1124-00 (2007/01/31)