<p> UK Power Networks CON 08 115b</p><p>SORN Request Form for HV ICP Jointing Activity – Mechanism 1</p><p>1 ICP Company Name <please complete></p><p>2 Project Name & Site Address <please complete></p><p>3 UK Power Networks Project Number <please complete></p><p>4 UK Power Networks License Area <SPN / EPN / LPN></p><p>5 Work Start Date <please complete> 6 Work Finish Date <please complete></p><p>DNO HV Circuit ID – 7  Primary/MSS name & Feeder No. or name <please complete>  Circuit destination between Sub-Station’s</p><p>8 Description of work to be completed <please complete></p><p>Name and NERS Passport reference numbers of 9 jointing team(s) <please complete></p><p>ICP Declaration</p><p>I confirm all Works will be completed in accordance with the accepted design and the G81 design standards.</p><p>I understand that the Works will be limited to “connection activity” and will not include any “operational activity”.</p><p>I understand that the connection activity shall be completed in accordance with the ICP’s own Safe System of Work which shall be to no lesser standard than UK Power Networks policies & procedures.</p><p>I understand that the ICP shall have in place arrangements for emergency circuit restoration and have a nominated representative contactable for the duration of the works, inclusive of out of normal working hours.</p><p>Name: <please complete> Position: <please complete> Signature: <insert signature> Date: <insert></p><p>Version 2.1 UK Power Networks Use Only</p><p>SORN Status Date Name Signature Provisional <insert> <please complete> <insert signature> Confirmed <insert> <please complete> <insert signature> Withdrawn <insert> <please complete> <insert signature> Site Completion <insert> <please complete> <insert signature> Closed <insert> <please complete> <insert signature></p><p>SORN Reference Number HV-M101 SORN Version Number v1.0</p><p>SORN Version Comments Date of Revision Number V2.0 V3.0 V4.0</p><p>Version 2.1</p>