The document is a registered inspector's inspection certificate for a proposed internal partition works project at an existing building. It summarizes the approved fire safety plans, certifies that the fire safety works were carried out according to the approved plans and relevant codes and regulations, and declares that the registered inspector has no conflicts of interest regarding the project. The inspector's name, registration number, signature and date are provided.

1. Form 1
The Fire Safety Act
(Chapter 109A)
The Fire Safety (Registered Inspectors) Regulations
( Regulation 11 (1) (a) )
Registered Inspector’s Inspection Certificate
The Commissioner
Singapore Civil Defence Force
91 Ubi Avenue 4
Singapore 408827
Attn: Director, Fire Safety & Shelter Department
FSSD Approved Plans:
DBP/A02368/13 & DFP/A02368/13
Project Title: PROPOSED INTERNAL PARTITION WORKS TO PART OF 4TH STOREY OF
EXISTING NORTH TECH BUILDING ON LOT 3834L MK 13 AT NO. 29 WOODLANDS
INDUSTRIAL PARK E1 FOR M/S ILLUMINA SINGAPORE PTE LTD.
1. I CHEN KUM SENG NRIC No./ Passport No. 2557225D, being a Registered Inspector,
hereby certify that in accordance with Regulation 8 (1) and the First Schedule to the Fire Safety
(Registered Inspectors) Regulations, I have carried out an inspection of the fire safety works as
listed in Part II* of the First Schedule (* and that part of the fire safety works using the
alternative solution) in the above mentioned project.
2. I hereby confirm that the fire safety works in the project have been carried out in accordance
with the approved plans of fire safety works, the relevant codes of practice, the Fire Safety Act
and any Regulations made thereunder.
3. I hereby declare that I have no professional or financial interest in the project or other interest
that may conflict with my duties as the Registered Inspector for this project.
---------------------------------------------------------Registered Inspector’s Stamp and Signature
Date: ………………………………
*Delete where inapplicable
Valid w.e.f 1 Jul 2004