New Zealand Gazette – 2002 – No. 32

Page 960

✨ Gaming Machine Certification



NEW ZEALAND GAZETTE

No. 32

Appendix I - Certification And Indemnity Form

CERTIFICATION AND INDEMNITY FORM

I

__ (Full Name)

being

__ (Position Held)

for and on behalf of

__ (Supplier)

hereby certify that:

  1. the statements contained in the attached documents are to the best of my knowledge and belief true and correct in every detail and are a complete disclosure of the information requested,

  2. the Chief Executive Officer,
    (jurisdiction), and all other officers and officially appointed agents of the above mentioned body, acting within the scope of their duties and responsibilities, shall be indemnified and held harmless from and against all claims, suits, demands, damages and costs, expense, losses and/or actions of any kind in consequence of any official action taken in respect to this application and any patent, trademark or copyright claim relating thereto, and

  3. the items submitted are complete and operational.

Name/Description of Equipment __

signed at __

This day of 19 __

__ (signature of Deponent)

in the presence of

__ (signature of Witness)

Name and Address
of Witness



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Online Sources for this page:

VUW Te Waharoa — PDF NZ Gazette 2002, No 32


Gazette.govt.nz — PDF NZ Gazette 2002, No 32




✨ LLM interpretation of page content

🏭 Submission Requirements for Gaming Machine Technical Standards (continued from previous page)

🏭 Trade, Customs & Industry
Gaming Machines, Technical Standards, Submission Requirements, Software, Re-submission, Version Identification, Certification, Indemnity Form