APPLICATION FOR FINAL TYPE APPROVAL/ACCEPTANCE 1. PARTICULARS OF VENDOR i) (ii) 2. Full names of Company/Business .................................................................................................... P.O. Box.......................Tel No.: ..................Fax No................... Email …………………. Physical Address: Town....................Estate.....................Street/Road..................... Name of Building....................Floor................Room................... DESCRIPTION OF EQUIPMENT ITEM NO TYPE MANUFACTURER MAKE AND MODEL SERIAL NUMBER/IMEI COUNTRY OF ORIGIN 3. DETAILS OF INSTALLATIONS ITEM NO MAKE, MODEL, TYPE OF EQUIPMENT DATE PROVISIONALLY APPROVED BY CCK & REFERENCE NUMBER DATE OF INSTALLATION POSTAL, TELEPHONE , FAX, EMAIL & PHYSICAL ADDRESS OF REFERENCE CONTACT PERSON & RANK IN ESTABLISHME NT Please continue on a separate sheet. Also attach details of employees and their qualifications and details of workshop. 4. DECLARATION I hereby apply for Final Type Approval/Acceptance / authority to market the equipment(s) specified above in Kenya on behalf of my company I certify that all information I have given in this form is correct to the best of my knowledge. 80