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MINISTRY OF PUBLIC WORKS Form 27B/6
MINISTRY OF PUBLIC WORKS
Form 27B/6
Authorization for Repairs of Domestic Living Quarters by Licensed Repair Technicians
Issuing officer Name:......................................................................
Issuing officer ID Number:............................................................
Fill this form out in triplicate. One form is to be kept by Issuing Officer, Primary Technician, and Primary Resident.
Location of Repair Site
Room of house in which repair will be
performed:.................................................................
Residence Number:.................................................
Building Number:......................................................
Street Name:.............................................................
District Number:......................................................
City Name:.................................................................
Region Code:.............................................................
Country Name:.........................................................
Zone Information Number:..................................
Primary Resident:.....................................................
Primary Resident ID Number:...............................
Other Residents:......................................................
......................................................................................
......................................................................................
Attach form 31N/6 for any relevant medical conditions of
residents.
Repair Details
Repair Technicians
(please attach form 27H/44 for each technician)
Head Technician
Name:..........................................................................
License Number:......................................................
Secondary Technician (if any)
Name:..........................................................................
License Number:......................................................
Tertiary Technician (if any)
Name:..........................................................................
License Number:......................................................
Attach form 27L/97 if more than 3 technicians are to be
dispatched.
Equipment to be repaired
Name
Value
(broken)
(fixed)
.....................................................................................
.....................................................................................
.....................................................................................
.....................................................................................
Total value of repair:
Equipment to be used in repair:
ID Code
Name
Value
.....................................................................................
.....................................................................................
.....................................................................................
.....................................................................................
Equipment to be consumed in repair:
ID Code
Name
Value
......................................................................................
......................................................................................
......................................................................................
......................................................................................
Attach form 27Q/81 if more equipment is to be repaired
or used in repair.
Total cost of repair:.................................................
Net change in Ministry asset valuation:...............
Amount of repair cost to be paid by primary
resident:......................................................................
Issuing Officer Signature:
......................................................................................
Primary Technician Signature:
......................................................................................
Primary Resident Signature:
......................................................................................