New Zealand Gazette – 2004 – No. 79

Page 1988

✨ Certification and Indemnity Form



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 2004, No 79


Gazette.govt.nz — PDF NZ Gazette 2004, No 79




✨ LLM interpretation of page content

🏭 Certification and Indemnity Form for Suppliers

🏭 Trade, Customs & Industry
Certification, Indemnity, Supplier, Legal Document, Compliance