New Zealand Gazette – 2003 – No. 56

Page 1555

✨ Certification Form



NEW ZEALAND GAZETTE

27 MAY

1555

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 2003, No 56


Gazette.govt.nz — PDF NZ Gazette 2003, No 56




✨ LLM interpretation of page content

🏛️ Gaming Machine Regulations (continued from previous page)

🏛️ Governance & Central Administration
Game Details, Progressive Jackpot Features, Mathematics, Artwork, Gaming Machine, Technical Standards, Certification

🏛️ Certification and Indemnity Form

🏛️ Governance & Central Administration
Certification, Indemnity, Supplier, Chief Executive Officer, Equipment