<p> Request for Certificate on Commercial Type Burglar Alarm System The Listed Company warrants this installation to be as represented under its annual care and maintenance contract and in full compliance with requirements of Underwriters’ Laboratories of Canada and requests a certificate in accordance with the information given herein.</p><p>Description Category*: Choose one Features Type*: Choose one Extent of Protection*: Choose one 3 Scheduled Opening/Closing*: Yes No 1 Line Security*: Choose one Status: New 2 Service Response*: Next Business Day Term: 5 Years Supervised Circuits*: Yes No 4</p><p>Subscribers Control Unit (Transmitter) Model*: ULC or cUL Label Number*: All Connected Signalling and Transmitting Devices are ULC or cUL Listed and Labeled*: Yes No 5</p><p>Listee*: 6 ID Number*: Location*: Monitoring Company*: 7 ID Number*: Location*: Installing Company*: 8 ID Number*: Location*: </p><p>Certificate Language Preference*: English French Comments / Special Conditions:</p><p>Occupant* Name*: Address*: City*: Province*: Postal Code*: Subscriber #: </p><p>Alarm Monitoring Company Representative Name*: Phone*: Email*: Alarm Installing Company Representative Name*: Phone*: Email*: * denotes required fields</p><p>NOTES: 1. Scheduled Openings/Closings are required on all Types of Systems except Premise – Medium Protection Level and Premise – Low Protection Level. 2. Only use this form for new certificates. Modifications or cancellations of existing certificates should be handled via email to [email protected]. Please include the certificate number, occupant name and address in the email. 3. Extent of Protection must be Complete for Vaults, Safes, Automated Banking Machines, and Night Deposits. 4. Supervised Circuits are required on all Types of Systems except Premise – Low Protection Level. 5. This includes, but is not limited to: Intrusion Detection Devices, Dialer/GSM/Internet Modules, and Expander Modules. 6. Listee is the location of the head office of the monitoring company. 7. Monitoring Company is the location of the monitoring station that will do the actual monitoring of the occupant. This may or may not be the same as the Listee. 8. Installing Company is the company that visits the occupant’s site to perform the ongoing maintenance and testing.</p><p>Please complete form and return via email to [email protected]</p><p>FES_F_500_ISSUE04_JAN2013ENG</p>