I/We, Name: …………………………………………………………………………………………………………………………

Address: …………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………...

Postcode: ………………………………………………. Telephone Number: ………………………………………………..

hereby certify that with regard to the accompanying operations notice dated (insert date): ……………………………...

given by or on behalf of (insert name of the Developer in the operations notice): …………………………………………

relating to operations at: (the site of the proposed operations): ……………………………………………………………..

(tick ü whichever applies)

I/We have an interest in the site of the operations which (apart from any restrictions imposed by law) entitles me/us to carry out the operation in question.

I/We have a right to enter on and take possession of the site of the operations in question under Section 11 (1) or (2) of the Compulsory Purchase Act 1965 (powers of entry on land subject to compulsory purchase).

This certificate is issued by statutory undertakers entitled to carry out the operations in question by or under the following enactment (footnote 1, insert name of enactment).

………………………………………………………………………………………………………………………………………...

Signature ………………………………………………………. Date: ………………………………………………………

On behalf of: ………………………………………………………………………………………………………………………..

Name of any agent(s) to whom correspondence should be sent : …………………………………………………………..

Address: …………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………...

Postcode: ………………………………………………… Telephone Number ………………………………………………

I (name of person issuing this certificate) ………………………………………………………………………………………

Hereby state that I have authorised the Developer mentioned in the accompanying operations notice dated …………

to carry out the operations referred to in that notice.

FOOTNOTE

1. "Enactment" includes an enactment in any local or private Act of Parliament, and order, rule, regulation, bye-law or scheme made under an Act of Parliament: (Section 61 (1) ) of the 1979 Act.

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If any person issues a certificate which purports to comply with the requirements of this form and which contains a statement which he knows to be false or misleading in a material particular, or recklessly issues a certificate which purports to comply with these requirements and which contain a statement which is false or misleading in a material particular, he shall be guilty of an offence.