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Details of Undertaker

Account Number:

Undertaker Name:

Vat Reg. Number:

Physical Address:

Postal Address:

Maximum Body Capacity:

Contact Person

Title:

Initials:

First Name:

Surname:

ID Number:

Telephone:

Cellphone Number:

Fax Number:

Email Address:

Certificate of Competency

Designation Number:

Competency Date: