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Population Certificate Application For official use only Permanent / Temporary Delete which is not applicable Application No. File No. Application for a Population Certificate is made in terms of Section 21 1 of the Community Fire Safety By-law. Name of applicant ID no Name of business Telephone No. Cell No. Type of business e.g. bar nightclub etc Erf No On what floor of the building is the venue situated i.e. ground 1 st etc Street address Suburb Code Details of Premises How many floors does the building have this application is being made Expected Population Square metres of usable area per floor of venue Indicate a separate square meterage for each floor occupied by the venue in the blocks below Tent Floor Number of exits per floor Indicate exits per floor separately in the blocks below 1 The controlling authority may refuse to issue the certificate applied for if the premises do not comply with the requirements of the National Building Regulations. issuing of the certificate. 3 The certificate is valid only for the premises for which it is issued and is not transferable. 4 If the occupancy or ownership of the premises changes the owner or person in charge must apply for a new certificate. Signature of applicant Print Name Date Address For Controlling Authority Signature A certificate fee of per 15 minutes spent on site is payable to THE CITY OF CAPE TOWN in respect of this application and the subsequent inspection*. issuing of the certificate. 3 The certificate is valid only for the premises for which it is issued and is not transferable. 4 If the occupancy or ownership of the premises changes the owner or person in charge must apply for a new certificate. 4 If the occupancy or ownership of the premises changes the owner or person in charge must apply for a new certificate. Signature of applicant Print Name Date Address For Controlling Authority Signature A certificate fee of per 15 minutes spent on site is payable to THE CITY OF CAPE TOWN in respect of this application and the subsequent inspection*. issuing of the certificate. 3 The certificate is valid only for the premises for which it is issued and is not transferable. 4 If the occupancy or ownership of the premises changes the owner or person in charge must apply for a new certificate. Signature of applicant Print Name Date Address For Controlling Authority Signature A certificate fee of per 15 minutes spent on site is payable to THE CITY OF CAPE TOWN in respect of this application and the subsequent inspection*. .

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