Fax2Email: 086 540 6462 VAT REGISTRATION NUMBER: 45 00 11 67 61
Application for REGISTRATION with SAQCC Gas asan
AUTHORISED REFRIGERATION GAS PRACTITIONER
I apply for registration as a REFRIGERATION PRACTITIONER in terms of the OH&S Act 85 of 1993 and the “Pressure Equipment Regulation” R734 of 15th July 2009:
Please follow this checklist when completing and submitting your application form:
REQUIRED: / 1 / FOUR (4) recent COLOUR PASSPORTsize photographs of the applicant, with own name and ID number on the reverse side, inserted in an envelope and attached to this form.
Please note we cannot accept paper / printed photographs.
2 / A CERTIFIED photocopy of a valid IDENTITY DOCUMENT must be attached to this form
3 / Attach COPIES of all relevant CERTIFICATES/QUALIFICATIONS
4 / The attached CODE OF GOOD PRACTICE must be COMPLETED and SIGNED BY THE APPLICANT (at bottom of page)
5 / PROOF OF PAYMENT must be attached to this form. We are unable to process this application until payment has been made
6 / Post the application via REGISTERED POST to:
SARACCA,POBOX 75912, GARDENVIEW, 2047
PAYMENT GUIDELINES: /
* / Payment of R1824.00 (including VAT) must be made by electronic transfer to SARACCA, or a direct deposit can be made and a copy of the deposit slip attached.
* / Account Details:
First National Bank, Branch No: 252155, BedfordGardens,
Account No: 59630030903
* / Use your initials and surname for reference
* / If paid by a VAT Registered Company, please provide us with a company letter confirming the VAT registration number in writing
I confirm that the information provided by me in my application is correct, valid and that I shall sign and abide by the SAQCC gas Code of practice attached
SIGNED…………………………………………….. DATE………………………
APPLICANT DETAILS:
First names / PhotoThe photograph will be attached by SARACCA
Surname
ID no.
Telephone No.
E mail address
Fax no.
Cell phone
Postal address / Postal address to which card will be sent / Residential
Box Number / Unit/Flat no
Town / No & street
Province / Suburb/town
Code / Code
OR / Card to be collected / Yes
EMPLOYER DETAILS:
Employer Name to be printed on card:-Postal Box No / Contact Person
Suburb/Town / Email Address
Province / Telephone No
Postcode / Fax no
Co VAT No
ENSURE COMPLETION OF “SUBURB/TOWN” AND PROVINCE AS THIS IS CAPTURED ON THE SAQCC DATABASE
EDUCATION AND QUALIFICATIONS
PLEASE ATTACH COPY OF CERTIFICATES, QUALIFICATION DOCUMENTS AND TRADE REGISTRATION PAPERS
YEAR / Grade passed/ QualificationHigh School
Tertiary Education
Apprenticeship
Learner ship
Skills program
Safe handling re assessment Unit Standards:
US 116700 for Freon gases / US 116223 / US 116334 / US 116355
or US 116704 / For Ammonia (NH³)
Training Provider:
Signed By Assessor:
PLEASE ATTACH A COPY OF YOUR ASSESSMENT CERTIFICATE
EXPERIENCE
YOU MUST DETAIL YOUR EXPERIENCE IN REFRIGERATION AND DEGREE OF RESPONSIBILITY
Employer / Years / Detail Experience in A/C and RefrigerationFrom / To
FAILURE TO PROVIDE ALL THE REQUESTED DOCUMENTATION WILL DELAY OR NULLIFY YOUR APPLICATION.
CATEGORY OF REGISTRATION FOR WHICH YOU ARE APPLYING
SELECT ONE CATEGORY ONLY BASED ON QUALIFICATIONS AND EXPERIENCE
CATEGORY / REGISTRATION TITLE / O / Handling of Refrigerants and Containers
A / Refrigeration plant operator safety awareness
A / Semi skilled Air Conditioning & Refrigeration Installer
A / Air Conditioning & Refrigeration Apprentice/Learner
B / Air Conditioning & Refrigeration Practitioner
B / Ammonia Refrigeration Practitioner
B / Motor Vehicle Air Conditioning Practitioner
B / Transport refrigeration practitioner
B / Marine refrigeration practitioner
C / Inspector – Commercial AC & R
C / Inspector - Industrial Refrigeration & AC
C / Designer – Commercial AC & R
C / Designer - Industrial Refrigeration
February 2014
Code of Good Practice for AUTHORISED REFRIGERATION Gas Practitioners
I, ID Number:
The undersigned, as a registered and authorised Gas Practitioner shall
1.undertake only those assignments which fall within my authorised level of registration and scope of work for which I am competent by virtue of training, experience and certification. Where warranted, advise on the engagement of such specialists who are required to facilitate the completion of the assignment.
2.Indicate to my employer, supervisor or mentor any adverse consequence that may result from an alteration to the designed installation by a non-technical authority or client.
3. Be objective, thorough and factual in any written report, statement or testimony of the work performed and include all relevant or pertinent information in such documents.
4.Sign only for work I have personally carried out or work which I supervised and have personal knowledge of through direct technical control.
5.Have proper regard for the safety, health and environment concerning the user, the public and the fellow employees
6.Protect to the fullest extent possible, constant with the well being of the gas industry and public, any information given in confidence to me by my employer, supervisor, colleague, and client, SARACCA and/or SAQCC Gas.
7.Strive to maintain proficiency by updating my personal technical knowledge and skills as required to efficiently and effectively applying the desired skills as required by an Authorised Refrigeration Practitioner within the Refrigeration and Air Conditioning industry.
8.Maintain the highest degree of personal integrity, credibility and business ethics at all times.
9.Report any unsafe practices, sub-standard work and non registered practitioners to the SAQCC Gas
10.Comply with the Anti Trust Policy and Meeting Rules as set out by SAQCC Gas and any other informed policy, regulation and/or standard promulgated.
11.Comply with the Occupation Health & Safety Act (No 85 of 1993) and all related and applicable regulations and the relevant SABS Standards and Codes of Practice.
PRACTITIONER SIGNATURE: ……………………...... DATE: ......
To BE FILLED IN BY THE REGISTRATION ADMINISTRATORSAQCC GAS REGISTRATION NO: / CARD EXPIRY DATE:
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C:\My Documents\ARP\FORMS\February 2014\ARP Form rev 11 - Feb 2014.doc