STRUCTURAL STABILITY CERTIFICATE REQUEST
Request date: __________
Applicant/owner: __________, __________, capacity __________..
Building: __________ (__________), __________, site area __________ sq m. Title/allotment: __________. Jurisdiction __________; authority __________.
- PURPOSE
Certificate required for: __________..
- STRUCTURE
Structural system: __________. Height: __________ m. Floors: __________. Drawing availability: __________.
- CONDITION
Visible distress: __________.
- PROPOSED CHANGE / LOAD
Status: __________.
- ASSESSMENT
Requested scope: __________. Documents supplied: __________.
- PROFESSIONALS
..
Please inspect and independently determine whether stability can be certified, stating assumptions, limitations, tests performed and any remedial work required before certification.
PERSONAL DATA NOTICE
This notice is given under the Digital Personal Data Protection Act, 2023.
Personal data in this document is collected only to commission and retain an independent structural-stability assessment and certificate, communicate about that purpose, verify expressly supplied property and approval information, and retain an evidentiary application record.
The record will be held by __________ and may be shared only with the applicant, owner, architect, engineer, licensed professional, project consultant, lender, contractor, competent planning/building/fire/environment/water authority, or other person directly involved in the stated approval.
If the application is withdrawn, refused or does not proceed, personal data will be retained for 90 days and then erased. If it proceeds, the record will be retained for the approval/project plus 12 months, except where a statute or authority record-retention rule requires a longer named period.
A person named here may withdraw consent for future consent-based processing, request correction or erasure when the stated purpose has ended, or raise a grievance by writing to __________. The record-holder should acknowledge and respond within 30 days.
Data minimisation: this document does not collect a full Aadhaar number, an Aadhaar-card copy, a password or unrelated financial credentials, and none should be written into it. Collect identity and professional-registration details only where the receiving authority actually requires them.
Personal-data instruction: __________.
Record-holder: __________
SIGNATURE
Applicant: __________