This certificate is not valid if the serial ICN3/0510316 ...

PART P NUMBER: 9838582

ELECTRICAL INSTALLATION CERTIFICATE

This certificate is not valid if the serialnumber has been defaced or altered ICN3/0510316

Issued in accordance with British Standard 7671 - Requirements for Electrical Installations by anApproved Contractor or Conforming Body enrolled with NICEIC, Warwick House,Houghton Hall Park,Houghton Regis,Dunstable,LU5 5ZX

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Please see the 'Notes for Recipients'

on the reverse of this pageThis form is based on the model shown in Appendix 6 of BS7671 (as amended).Published by Certsure LLP. © Copyright Certsure LLP (May 2013)

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DETAILS OF THE CLIENT

Client /Address: Postcode: SW10 9HA

DETAILS OF THE INSTALLATION

Address: 12 High STreet, Berkhamsted, Herts Postcode: HP4 3RT

Extent of theinstallationcovered by thiscertificate:

NEW INSTALLATION:FUSEBOX AND SOCKETS:

The installation is:

New á

Anaddition á

Analteration á

DESIGN

The extent of liabilty of the signatory/signatories is limited to the work described above as the subject of this certificate.For the DESIGN of the installation: ** (Where there is divided responsibility for the design)

I/We, being the person(s) responsible for the design of the electrical installation (as indicated by my/our signature(s) below), particulars of which aredescribed above, having exercised reasonable skill and care when carrying out the design, hereby CERTIFY that the design work for which I/we have beenresponsible is, to the best of my/our knowledge and belief, in accordance with BS 7671 amended toexcept for the departures, if any, detailed as follows:

Details of departures from BS 7671, as amended (Regulations 120.3,133.5):

(date)

Signature Date Name (CAPITALS) Designer 1

Signature Date Name (CAPITALS) Designer 2**

CONSTRUCTION

The extent of liabilty of the signatory is limited to the work described above as the subject of this certificate.For the CONSTRUCTION of the installation:

I/We, being the person(s) responsible for the construction of the electrical installation (as indicated by my/our signature below), particulars of which aredescribed above, having exercised reasonable skill and care when carrying out the construction, hereby CERTIFY that the construction work for which I/we have beenresponsible is, to the best of my/our knowledge and belief, in accordance with BS 7671 amended toexcept for the departures, if any, detailed as follows:

Details of departures from BS 7671, as amended (Regulations 120.3,133.5):

(date)

Signature Date Name (CAPITALS) Constructor

INSPECTION AND TESTING

I/We, being the person(s) responsible for the inspection and testing of the electrical installation (as indicated by my/our signatures below), particulars of which aredescribed above, having exercised reasonable skill and care when carrying out the inspection and testing, hereby CERTIFY that the work for which I/we have beenresponsible is, to the best of my/our knowledge and belief, in accordance with BS 7671 amended toexcept for the departures, if any, detailed as follows:

Details of departures from BS 7671, as amended (Regulations 120.3,133.5):

(date)

The extent of liabilty of the signatory/signatories is limited to the work described above as the subject of this certificate.For the INSPECTION AND TESTING of the installation:

Signature Date

Name (CAPITALS) Inspector

Signature Date

Name (CAPITALS) QualifiedSupervisorÚ

DESIGN, CONSTRUCTION, INSPECTION AND TESTING * * This box to be completed only where the design, construction,inspection and testing have been the responsibility of one person.

I, being the person responsible for the design, construction, inspection and testing of the electrical installation (as indicated by my signature below), particulars of whichare described above, having exercised reasonable skill and care when carrying out the design, construction, inspection and testing, hereby CERTIFY that the said workfor which I have been responsible is to the best of my knowledge and belief, in accordance with BS 7671, amended toexcept for the departures, if any, detailed as follows:

Details of departures from BS 7671, as amended (Regulations 120.3,133.5):

(date)

The extent of liabilty of the signatory is limited to the work described above as the subject of this certificate.For the DESIGN , the CONSTRUCTION and the INSPECTION AND TESTING of the installation: Reviewed by

Signature Date

Name (CAPITALS)

Signature Date

Name (CAPITALS) QualifiedSupervisorÚÚ

ÚÚÚ

Where the inspection and testing have been carried out by an Approved Contractor, the inspection and testing results are to be reviewed by the registered Qualified Supervisor.Where the design, the construction, and the inspection and testing have been the responsibilty of one person, the inspection and testing results are to be reviewed by theregistered Qualified Supervisor.

John Smith

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This certificate is not valid if the serialnumber has been defaced or altered ICN3/0510316

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SCHEDULE OF ITEMS INSPECTED Ú See note below

PROTECTIVE MEASURES AGAINST ELECTRIC SHOCK

Basic and fault protection

Extra low voltage

Double or reinforced insulation

SELVá PELVN/A

Double or Reinforced Insulationá

Basic Protection

Insulation of live partsáObstacles **N/A

Barriers or enclosuresáPlacing out of reach **N/A

Fault protection

Automatic disconnection of supply

Presence of earthing conductoráPresence of circuit protective conductorsáPresence of main protective bonding conductorsáPresence of earthing arrangements for combinedprotective and functional purposesáPresence of adequate arrangements for alternativesource(s), where applicableN/A

FELVáChoice and setting of protective and monitoring devices(for fault protection and/or overcurrent protection)á

Non-conducting location **

Absence of protective conductorsN/A

Earth-free equipotential bonding**

Presence of earth-free equipotential bondingN/A

Electrical separation

For one item of current using equipmentáFor more than one item of current using equipment**N/A

Additional protection

Presence of residual current device(s)áPresence of supplementry bonding conductorsá

** for use in controlled supervised/conditions only

Prevention of mutual detrimental influence

Proximity of non-electrical services and other influencesáSegregation of Band I and Band II circuits or Band IIinsulation usedáSegregation of safety CircuitsN/A

Identification

Presence of diagrams, instructions, circuit charts andsimilar informationáPresence of danger notices and other warning noticesáLabelling of protective devices, switches and terminalsáidentification of conductorsá

Cables and Conductors

Selection of conductors for current carrying capacity andvoltage dropá

Erection methodsáRouting of cables in prescribed zonesáCables incorporating earthed armour or sheath or run in anearthed wiring system, or otherwise protected against nails,screws and the like

á

Additional protection by 30mA RCD for cables concealed in walls(where required,in premises not under the supervision of skilledor instructed persons)

á

Connection of conductorsáPresence of fire barriers, suitable seals and protection againstthermal effectsá

General

Presence and correct location of appropriate devices forisolation and switchingá

Adequacy of access to switchgear and other equipmentáParticular protective measures for special installations and locationsáConnection of single-pole devices for protection orswitching in line conductors onlyá

Correct connection of accessories and equipmentáPresence of undervoltage protective devicesN/A

Selection of equipment and protective measuresappropriate to external influencesá

Selection of appropriate functional switching devicesá

SCHEDULE OF ITEMS TESTED Ú See note below

External earth fault loop impendance,ÑáInstallation earth electrode resistance, RÕN/A

Continuity of protective conductorsáContinuity of ring final circuit conductorsáInsulation resistance between live conductorsáInsulation resistance between live conductors and EartháProtection by seperation of circuitsá

Basic protection by barrier or enclosureprovided during erectionN/A

Insulation of non-conducting floors or wallsN/A

PolarityáEarth fault loop impendance,ÖáVerification of phase sequenceáOperation of resudual current devicesáFunctional testing of assembliesáVerification of voltage dropá

Ú All boxes must be completed. 'á' indicates that an inspection or a test was carried out and that the result wassatisfactory. 'N/A' indicates that aninspection or a test was not appl icable to the particular installation

* Where the electrical works to which this certificate relates includes the installation of a fire alarm system and/or an emergency lighting system (or a partof such system), this electrical safety certificate should be accompanied by the particular certificate(s) for the system(s).

SCHEDULE OF ADDITIONAL RECORDS* (See attached schedule)Note: Additional page(s) must be identified by the Electrical Installation Certificate serial number and page number(s).

Page No(s)

This form is based on the model shown in Appendix 6 of BS7671 (as amended).Published by Certsure LLP. © Copyright Certsure LLP (May 2013)