METHOD STATEMENT FOR PRECOMMISSIONING & COMMISSIONING OF CHILLERS

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Method Statement

Precommissioning & Commissioning of Chillers

Company / Contractor Name:  [ENTER COMPANY / CONTRACTOR NAME]

Doc No:  [DOC NO.]

Document No.	[ENTER DOCUMENT NUMBER]	Revision	00
Project Location	[ENTER PROJECT LOCATION]	Project Name	[ENTER PROJECT NAME]
Project No.	[ENTER PROJECT NUMBER]	Prepared By	[NAME / DESIGNATION]
Date	[DD/MM/YYYY]	Reviewed By	[NAME / DESIGNATION]
Approved By	[NAME / DESIGNATION]	Client / Owner	[ENTER CLIENT / OWNER NAME]
Main Contractor	[ENTER MAIN CONTRACTOR NAME]	Sub-Contractor	[ENTER SUB-CONTRACTOR NAME]
Applicable Standards	ASHRAE 90.1 / ISO 9001:2015 / ISO 45001:2018 / [PROJECT SPECIFICATIONS REFERENCE]

⚠ All fields in [RED BRACKETS / ITALIC] are placeholders. Replace each with your project-specific information before issue or use. Provided free of charge by HSE Documents for global HSE professionals.

Table of Contents

1. Purpose

2. Scope of Work

3. Responsibilities

4. Required Tools & Equipment

5. Materials

6. Handling & Storage

6.1 Fabrication / Pre-assembly

6.2 Receipt & Inspection at Site

6.3 Unloading, Shifting & Storage

7. Installation / Work Procedure

7.1 Pre-Commencement Checks  |  7.2 Precommissioning  |  7.3 Commissioning  |  7.4 Performance Testing  |  7.5 Interfaces

8. Health, Safety & Environment

9. Quality Control & Inspection

10. Reference Documents

11. Document Revision History

12. Approval & Sign-Off

1. Purpose

This Method Statement establishes the documented procedure for the precommissioning and commissioning of water-cooled and/or air-cooled chillers, including associated auxiliary systems, instrumentation, and controls, in strict accordance with the manufacturer's recommendations, project specifications, and applicable international standards. It governs all preparatory, inspection, start-up, testing, and handover activities undertaken by [ENTER COMPANY / CONTRACTOR NAME] on the project [ENTER PROJECT NAME].

The purpose of this document is to define the sequence of activities, safety controls, quality hold points, and responsibilities required to safely and successfully execute chiller commissioning works whilst maintaining compliance with ISO 9001:2015 (Quality), ISO 45001:2018 (Health & Safety), and ISO 14001:2015 (Environment), as well as the regulatory requirements of [LOCAL AUTHORITY / REGULATORY BODY NAME].

This document shall be read in conjunction with the approved construction drawings, equipment manufacturer's Installation, Operation and Maintenance (IOM) manuals, project specifications, Risk Assessment reference [ENTER RA REFERENCE], and the project Inspection and Test Plan (ITP) reference [ENTER ITP REFERENCE]. Any conflict between this document and project specifications shall be immediately reported to the [PROJECT ENGINEER / CLIENT REPRESENTATIVE] for resolution prior to proceeding.

2. Scope of Work

This Method Statement covers the following activities associated with the precommissioning and commissioning of chiller plant and associated systems:

• Receipt, inspection, and off-loading of chiller units and associated auxiliary equipment upon delivery to site.
• Pre-commissioning checks: verification of mechanical installation, refrigerant piping connections, condenser water and chilled water pipework connections, electrical connections, and control wiring.
• Verification of all associated isolation valves, strainers, balancing valves, and expansion vessels against approved shop drawings.
• Leak testing of refrigerant circuits in accordance with EN 378 / ASHRAE 15 requirements.
• Verification of factory refrigerant charge or site charging, as applicable.
• Electrical supply verification, meggering of motor windings, and earth continuity testing.
• Initial start-up, commissioning, and running-in of chiller units under part-load and full-load conditions.
• Verification of chiller controls, BAS/BMS integration, safeties, and alarm functions.
• Commissioning of pumps, cooling towers, and condenser water systems in interface with chiller operation.
• Performance testing, including capacity verification, COP measurement (where required), and logging of operating parameters.
• Documentation of commissioning results on chiller commissioning data sheets and submission to the QA/QC Inspector and Client.
• Witnessing by [CLIENT / CONSULTANT REPRESENTATIVE] at designated hold points as specified in the ITP.
• Final handover, O&M documentation compilation, and training of facility management personnel (if specified).

3. Responsibilities

Role / Designation	Responsibilities
Site Engineer / Commissioning Engineer	Overall technical oversight of precommissioning and commissioning activities; preparation and sign-off of commissioning data sheets; coordination with manufacturers' representatives; liaison with QA/QC Inspector and Client; ensuring work is executed in accordance with this Method Statement, drawings, and specifications.
Site Foreman / Chiller Commissioning Supervisor	Direct supervision of commissioning technicians and operatives on site; enforcement of safe systems of work; delivery of daily toolbox talks; control of access to energised plant areas; verification of pre-start checklist completion; ensuring calibrated test equipment is used and logged.
HSE Officer	Conducting site HSE inductions; daily site inspections; enforcing PPE compliance; reviewing and communicating the Risk Assessment; issuing Permit to Work (PTW) where required; investigation of incidents and near misses; ensuring emergency procedures are understood by all personnel.
QA/QC Inspector	Witnessing designated hold points and witness points per the approved ITP; signing off inspection records and commissioning data sheets; reviewing non-conformances and issuing NCRs; maintaining documentation registers for all commissioning submittals.
Manufacturer's Representative (if applicable)	Providing technical guidance on chiller start-up sequence; confirming factory settings and control parameters; witnessing and certifying initial start-up and performance runs; issuing manufacturer commissioning certificate.

Additional roles may be added as required per [PROJECT / COMPANY ORGANISATIONAL CHART REFERENCE].

4. Required Tools & Equipment

1. Calibrated digital manifold gauge set (compatible with relevant refrigerant type, e.g. R-134a, R-410A, R-1234ze)
2. Refrigerant leak detector (electronic, calibrated and certificated)
3. Vacuum pump (dual-stage, minimum 7 CFM capacity) with micron gauge
4. Refrigerant recovery/charging unit and certified refrigerant cylinders
5. Calibrated clamp-on power analyser / multi-function power meter
6. Digital insulation resistance tester (Megger), rated minimum 1000V DC
7. Calibrated earth continuity / loop impedance tester
8. Calibrated digital thermometer with surface, immersion, and ambient probes (resolution ±0.1°C)
9. Calibrated differential pressure gauge / manometer
10. Ultrasonic flow meter (clamp-on type) for chilled water and condenser water flow measurement
11. Torque wrench set (metric and imperial)
12. Digital tachometer / stroboscope for pump and fan speed verification
13. Vibration analyser / data logger
14. Network/BAS laptop with relevant commissioning software and BMS interface cables
15. Personal gas monitor / refrigerant detector (for enclosed plant room use)
16. Nitrogen pressure cylinder with regulator (for leak testing)
17. Standard hand tools: adjustable spanners, screwdrivers, Allen key set, pipe wrenches
18. Personal Protective Equipment (refer to Section 8)
19. Calibration certificates for all test instruments — valid and in date at time of use

5. Materials

All materials shall be in strict accordance with the approved material submittals and project specifications. No substitutions shall be made without written approval from [CLIENT / ENGINEER NAME]. All refrigerants, oils, and chemical additives shall be accompanied by a current Safety Data Sheet (SDS) maintained on site.

• Chiller unit(s) — approved manufacturer and model as per approved material submittal
• Refrigerant (type as specified: [e.g. R-134a / R-410A / R-1234ze]) — virgin grade, certified cylinders with SDS
• Compressor oil / lubricant (manufacturer-specified grade)
• Flexible anti-vibration connections (chilled water and condenser water, EPDM or approved equal)
• Shut-off and balancing valves, strainers, and expansion vessels (as specified)
• Water treatment chemicals (inhibited glycol solution or biocide as specified) with SDS
• Chilled water and condenser water system flushing chemicals (as per approved chemical treatment programme)
• Electrical terminal lugs, cable glands, and conduit fittings (project-specified type and rating)
• Pipe insulation lagging (where required for commissioning completion, project-specified specification)
• Consumables: thread seal tape, jointing compounds, consumable fittings
• Commissioning data sheets and record forms (as per approved ITP)

6. Handling & Storage

6.1 Fabrication / Pre-Assembly (If Applicable)

Where chiller skid assembly or prefabricated pipework spools are prepared off-site or in a designated fabrication area, all works shall be carried out in accordance with the project specifications and manufacturer requirements. Completed sub-assemblies shall be tagged, inspected, and documented prior to transfer to the installation area. Refrigerant-containing components shall not be fabricated or modified without manufacturer authorisation.

6.2 Receipt & Inspection at Site

Upon delivery, each chiller unit and associated ancillary equipment shall be subject to the following:

• Verification of delivery documents, packing list, and approved material submittal against actual delivered items.
• Visual inspection for damage, dents, corrosion, or transit damage to refrigerant piping, control panels, and structural frames.
• Verification that factory refrigerant holding charge (nitrogen or refrigerant) is intact via pressure gauge reading. Any loss of holding charge shall be reported immediately to the manufacturer.
• Inspection of all ancillary items: sensors, controls, valves, and documentation packs (IOM manuals, wiring diagrams, commissioning guides).
• All non-conforming or damaged items shall be tagged, segregated, and documented on a Non-Conformance Report (NCR). No damaged equipment shall be installed without written resolution from [ENGINEER / CLIENT].
• Delivery inspection records shall be signed by the Site Engineer and submitted to the QA/QC Inspector.

6.3 Unloading, Shifting & Storage

• Chiller units shall be lifted using manufacturer-approved lifting points only. Lifting lugs, spreader beams, and slings shall be rated and certified for the equipment load.
• A Lifting Plan and Risk Assessment shall be prepared and approved prior to any crane or forklift lifting operation.
• Equipment shall be stored on a level, dry surface, protected from direct weather and contaminants. Factory packaging shall be retained until immediate installation.
• Control panels and electrical components shall be stored in a weatherproof, temperature-controlled environment in accordance with manufacturer requirements.
• Refrigerant cylinders shall be stored upright, secured against falling, segregated from ignition sources, clearly labelled, and maintained with current SDS on site.
• All stored items shall be clearly identified and tagged. Damaged or quarantined items shall be physically separated from serviceable stock.

7. Installation / Work Procedure

7.1 Pre-Commencement Checks

7.1.1 Verify that all prerequisite works are complete: civil bases cured to specified strength; pipework systems installed, flushed, and pressure-tested; electrical distribution boards energised and ready for connection; BMS/BAS wiring complete to chiller control panel terminals.

7.1.2 Confirm receipt of all applicable permits: Permit to Work (PTW) for electrical isolation and refrigerant handling; confined space entry permit (if applicable for basement plant rooms); hot work permit (if any brazing activity remains outstanding).

7.1.3 Conduct a pre-start Toolbox Talk (TBT) covering the specific hazards of chiller commissioning: refrigerant handling, electrical isolation, hot surfaces, manual handling, and emergency procedures. Record attendance.

7.1.4 Confirm all commissioning personnel hold relevant qualifications: refrigerant handling certification (F-Gas or equivalent), electrical competency, and site-specific HSE induction.

7.1.5 Verify calibration certificates for all test instruments are current and in-date. Record instrument details (make, model, serial number, calibration date, next due date) on the commissioning data sheet.

7.1.6 Confirm that IOM manuals and approved commissioning data sheets are available on site.

7.2 Precommissioning Verification

7.2.1 Inspect mechanical installation: confirm chiller is level (within manufacturer's tolerance, typically ±2mm per metre), anti-vibration mounts are correctly installed and free from shipping brackets, and all structural hold-down bolts are torqued to specification.

7.2.2 Verify all chilled water and condenser water pipework connections to evaporator and condenser headers. Confirm flexible connections are installed correctly and direction of flow aligns with approved drawings.

7.2.3 Confirm water-side isolation valves, strainers, and balancing valves are installed and accessible. Verify strainer screens are clean.

7.2.4 Verify refrigerant circuit integrity: confirm all factory refrigerant connections are intact; inspect sight glass, filter-drier, and expansion device (EXV) for correct installation and accessibility.

7.2.5 Conduct refrigerant leak test using an electronic leak detector. For factory-charged units, check all field joints, connections, and service ports. For site-charged units, perform nitrogen pressure test at specified test pressure (in accordance with EN 378 / ASHRAE 15), hold for minimum 24 hours, and verify zero pressure loss before proceeding.

7.2.6 For site-charged units: draw vacuum on refrigerant circuit to ≤500 microns using dual-stage vacuum pump. Record micron readings at start, mid, and end of vacuum period. Verify standing vacuum (blank-off test) prior to refrigerant charging.

7.2.7 Charge refrigerant to manufacturer-specified weight (kg) using calibrated charging equipment. Record cylinder batch numbers, quantity charged, and final operating pressures.

7.2.8 Inspect electrical panel: verify wiring terminations are correct, cable sizes and circuit breaker ratings match the approved single-line diagram and wiring schedule. Check all terminals are tight and free from insulation damage.

7.2.9 With main isolator OFF and LOTO applied, perform insulation resistance (megger) test on compressor motor windings: phase-to-phase and phase-to-earth at 500V DC. Record readings. Minimum acceptable resistance: ≥1 MΩ (verify against manufacturer specification).

7.2.10 Verify earth continuity from chiller chassis to electrical distribution board earth bar. Record test results.

7.2.11 Confirm BMS/BAS control signal wiring: verify all analogue and digital inputs/outputs are terminated per the approved controls wiring schedule. Confirm control power supply voltage matches panel requirements.

7.2.12 Verify oil level in compressor sight glass (where accessible) and confirm crankcase heater has been energised for the manufacturer-specified period (typically minimum 8–24 hours prior to start-up) to drive off refrigerant migration.

7.3 Initial Start-Up & Commissioning

7.3.1 Confirm water-side systems are operational: chilled water and condenser water pumps running, systems filled, vented, and at specified operating pressure. Verify water flow rates are within manufacturer's minimum required range using clamp-on flow meter. Record flow rates.

7.3.2 Verify chiller setpoints are programmed in the controller per design intent: chilled water leaving temperature setpoint, condenser water entering temperature setpoint, safety cut-outs (low refrigerant pressure, high discharge pressure, low oil pressure, motor overcurrent, flow switches).

7.3.3 Enable main electrical supply to chiller panel. Verify supply voltage: phase-to-phase and phase-to-neutral. Confirm correct phase rotation using phase sequence tester. Record supply voltage readings.

7.3.4 Initiate chiller start-up sequence via controller or BMS in accordance with the manufacturer's IOM manual. Monitor compressor start and confirm all safety interlocks are satisfied. Observe start-up for any abnormal sounds, vibration, or alarms.

7.3.5 Monitor and record operating parameters at 15-minute intervals during run-in period (minimum 2 hours continuous operation at stable load): suction pressure, discharge pressure, suction temperature, discharge temperature, leaving chilled water temperature (LCHWT), entering chilled water temperature (ECHWT), condenser water temperatures, compressor motor current (all phases), power input (kW), and refrigerant sight glass condition.

7.3.6 Verify chiller capacity modulation: confirm part-load operation is stable; verify capacity steps (cylinder unloading, variable speed drive response, or slide valve control as applicable) function correctly across the load range.

7.3.7 Test all safety controls: simulate low chilled water flow (trip flow switch), verify compressor shuts down and alarm activates. Restore and confirm restart. Test high pressure cut-out by throttling condenser water (with care, in short duration). Document each test result.

7.4 Performance Testing & Verification

7.4.1 Allow chiller to operate under stable, representative load conditions. Record all parameters on the project commissioning data sheet at full load and at part-load (if achievable): refrigerant temperatures and pressures, water temperatures entering and leaving evaporator and condenser, water flow rates, electrical power input.

7.4.2 Calculate effective chiller capacity (kW cooling) and COP (Coefficient of Performance) from measured data. Compare against design specification and manufacturer's published performance data at the recorded operating conditions. Document any deviations and report to [COMMISSIONING ENGINEER / CLIENT].

7.4.3 Verify BMS integration: confirm chiller status, fault alarms, setpoint adjustment, start/stop commands, and operating hours are correctly received and displayed at the BMS workstation.

7.4.4 Complete all commissioning data sheets in full. Obtain witnessed sign-off from QA/QC Inspector and [CLIENT / CONSULTANT REPRESENTATIVE] at designated ITP hold points.

7.5 Interfaces with Other Trades & Systems

7.5.1 Coordinate with the electrical contractor to confirm incoming power supply, distribution board labelling, and final electrical connections are complete and tested prior to chiller energisation.

7.5.2 Coordinate with the controls/BMS contractor to confirm control wiring, network addresses, and BAS integration points are commissioned and confirmed operational.

7.5.3 Coordinate with the plumbing/pipework contractor to confirm chilled water and condenser water systems have been flushed, chemical-dosed, pressure-tested, and signed off prior to chiller commissioning.

7.5.4 Coordinate with the cooling tower contractor (if applicable) to confirm cooling tower, make-up water, bleed system, and chemical dosing are fully operational prior to chiller condenser water commissioning.

8. Health, Safety & Environment (HSE)

All works shall comply with the project HSE Plan, the applicable regulations of [LOCAL HSE AUTHORITY / REGULATORY BODY NAME], and the requirements listed below:

• Toolbox Talk (TBT): A site-specific TBT shall be conducted before commencement of each working day and before any new commissioning phase begins. Attendance records shall be signed and retained. TBT topics shall address the specific activities of that day, including refrigerant handling, electrical work, and confined space entry.
• Mandatory PPE: Safety helmet; safety footwear (steel-toe, anti-static); high-visibility vest; safety glasses (chemical splash rated during refrigerant handling); nitrile or neoprene chemical-resistant gloves (for refrigerant and chemical handling); insulated electrical gloves (rated for working voltage); hearing protection where noise levels exceed 85 dB(A); face shield (during refrigerant charging / leak testing); respiratory protection (where refrigerant concentration risk exists in enclosed plant rooms).
• Working at Height: Where access to elevated components (cooling tower roof, rooftop chillers) is required, a Working at Height permit shall be issued. All fall protection equipment (harness, lanyard, anchor point) shall comply with BS EN 363 and OSHA 29 CFR 1926.502. Scaffolding or MEWP to be inspected and certified prior to use.
• Electrical Safety: LOTO (Lockout/Tagout) procedure shall be strictly enforced on all electrical isolation prior to any electrical work. Only competent, authorised electricians shall perform electrical connections. Live testing, where unavoidable, requires a two-person team and appropriate insulated PPE.
• Refrigerant Handling: Only certified refrigerant handling operatives (F-Gas certified or equivalent) shall charge, recover, or handle refrigerant. Recovery equipment shall be used for all refrigerant removal. Intentional venting of refrigerant to atmosphere is prohibited. SDS for each refrigerant type shall be available on site.
• Chemical / Substance Handling: All water treatment chemicals, refrigerants, and compressor oils shall be handled in accordance with their current SDS. COSHH/chemical risk assessment to be completed and communicated prior to use. Appropriate PPE, spill containment, and disposal procedures shall be in place.
• Confined Space: Where commissioning activities are conducted in enclosed or restricted plant rooms with inadequate ventilation, a Confined Space Entry permit shall be required. Atmospheric testing (oxygen, refrigerant concentration) shall be performed prior to and during entry.
• Manual Handling: Mechanical aids (trolleys, chain blocks, engine hoists) shall be used for lifting heavy components. Manual lifts exceeding [SPECIFY WEIGHT LIMIT PER LOCAL REGULATION] kg shall not be conducted without mechanical assistance. Manual handling technique training shall be confirmed for all operatives.
• Waste Management: All waste refrigerant shall be recovered and disposed of by a licensed contractor in accordance with local regulations and the project Environmental Management Plan. Chemical containers shall be disposed of as hazardous waste. General waste and recyclables shall be segregated on site.
• Emergency Procedures: Emergency muster point: [ENTER MUSTER POINT LOCATION]. First aid kit and eyewash station shall be available in the chiller plant room. Emergency services contact: [ENTER LOCAL EMERGENCY NUMBER]. In the event of refrigerant release, evacuate plant room, eliminate ignition sources, ventilate space, and contact HSE Officer immediately.

Permit to Work Requirements: [ENTER PTW REQUIREMENTS — e.g. Electrical Isolation PTW, Refrigerant Handling PTW, Confined Space Entry PTW, Working at Height PTW]

Risk Assessment Reference: [ENTER RA DOCUMENT REFERENCE NUMBER]

9. Quality Control & Inspection

All inspection and test activities shall be conducted in accordance with the project Inspection and Test Plan (ITP). Each hold point and witness point shall be signed off by the designated QA/QC Inspector before subsequent activities are permitted to proceed.

#	Inspection Activity	Reference Document	Acceptance Criteria
1	Material Delivery & Receipt Inspection — chiller unit, ancillaries, and documentation	Approved Material Submittal; IOM Manual; Packing List	No physical damage; holding charge intact; correct model/specification per submittal
2	Mechanical Installation Check — levelness, anti-vibration mounts, pipework connections	Approved Construction Drawings; IOM Manual	Level within ±2mm/m; connections per drawing; all shipping brackets removed
3	Refrigerant Leak Test (nitrogen or electronic) on all field connections and service points	EN 378 / ASHRAE 15; IOM Manual	Zero pressure loss over 24 hours (nitrogen test); no detectable leaks (electronic detector)
4	Vacuum Test — deep vacuum to ≤500 microns and standing vacuum (blank-off) test	IOM Manual; ASHRAE 15	Micron level achieved ≤500 microns; standing vacuum stable (no moisture or leak)
5	Electrical Inspection — wiring terminations, circuit breaker ratings, phase rotation, earth continuity	Approved Single-Line Diagram; IOM Manual; IEC 60364	Connections per wiring schedule; correct phase rotation confirmed; earth continuity <1Ω
6	Insulation Resistance (Megger) Test — compressor motor windings	IOM Manual; IEC 60034	Minimum ≥1 MΩ (or per manufacturer specification); results recorded and signed
7	Water Flow Verification — chilled water and condenser water flow rates	Approved Hydraulic Design Drawings; IOM Manual	Flow rates within manufacturer's specified range (min/max); results recorded
8	Initial Start-Up & Safety Controls Test — all protective devices and interlocks	IOM Manual; Project Commissioning Data Sheet	All safeties trip at correct setpoints; chiller shuts down and alarms annunciate correctly
9	Full-Load Performance Run — operating parameters recorded and compared to design	Design Specifications; IOM Manual; Commissioning Data Sheet	LCHWT achieved within ±0.5°C of setpoint; capacity within ±5% of design (or per spec)
10	BMS/BAS Integration Verification — control signals, alarms, setpoints, and data points	Approved Controls & BAS Points Schedule; Project Specification	All data points confirmed operational at BMS workstation; alarms and controls functional

ITP Reference: [ENTER ITP DOCUMENT REFERENCE NUMBER]

10. Reference Documents

• ISO 9001:2015 — Quality Management Systems
• ISO 14001:2015 — Environmental Management Systems
• ISO 45001:2018 — Occupational Health & Safety Management Systems
• ASHRAE Standard 15 — Safety Standard for Refrigeration Systems
• ASHRAE Standard 90.1 — Energy Standard for Buildings
• EN 378 — Refrigerating Systems and Heat Pumps — Safety and Environmental Requirements
• IEC 60364 — Low-Voltage Electrical Installations
• IEC 60034 — Rotating Electrical Machines
• IOSH Managing Safely — Risk Assessment and Method Statement Principles
• BS EN 363 — Personal Fall Protection Equipment
• OSHA 29 CFR 1926.502 — Fall Protection Systems Criteria
• ISO 16025 — Standards for Height Safety Equipment
• Approved Material Submittals — [ENTER REFERENCE]
• Approved Shop / Construction Drawings — [ENTER DRAWING REGISTER REFERENCE]
• Project Specifications — Section [ENTER RELEVANT SECTION NO., e.g. 23 60 00 — Central Cooling Equipment]
• Project HSE Plan — Ref: [ENTER REFERENCE]
• Inspection & Test Plan (ITP) — Ref: [ENTER REFERENCE]
• Risk Assessment — Ref: [ENTER REFERENCE]
• Chiller Manufacturer's IOM Manual — [ENTER MANUFACTURER AND DOCUMENT REFERENCE]

11. Document Revision History

Rev.	Date	Description of Change	Approved By
00	[DD/MM/YYYY]	Initial Issue	[NAME / DESIGNATION]
01	[DD/MM/YYYY]	[DESCRIBE REVISION]	[NAME / DESIGNATION]

12. Approval & Sign-Off

Prepared By	Reviewed By	Approved By	Client / Owner Representative
Name: [ENTER NAME] Designation: [ENTER DESIGNATION] Signature & Date	Name: [ENTER NAME] Designation: [ENTER DESIGNATION] Signature & Date	Name: [ENTER NAME] Designation: [ENTER DESIGNATION] Signature & Date	Name: [ENTER NAME] Designation: [ENTER DESIGNATION] Signature & Date

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