Technical Standards and Safety Authority 345 Carlingview Drive Toronto, Ontario M9W 6N9 Tel: 416.734.3300 Fax: 416.234.9169 Customer Service:1877.682.8772

Application for a Boiler/Pressure Vessel Certificate of Inspection Account

Under Ontario’s Technical Standards and Safety Act Boilers and Pressure Vessels Regulations

1. Owner/Operator InformationNote: All fields are mandatory. Certificate of Inspections and invoices will be mailed to this address.Company Name Corporation No./Business Identification Number

Contact Name Position Telephone No.

Alternate Telephone No: Email

Street No. Street Name

Town/City or Township Province Postal Code

2. Please complete the following chart for your Boiler and Pressure Vessel EquipmentNote: Attach additional sheets if necessary.

No. Specify Boiler = B or Pressure Vessel = P

TSSA Identification Number1Example: 65000000

Boiler Pressure Vessel Location (Address, City, Province, Postal Code)

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1 The TSSA identification number will be 8 digits and found on the Record of Inspection and listed as: “TSSA ID”, “TSSA UI”, “Jurisdiction Number”, etc. If you are unable to locate this

3. Insurer InformationNote: This information will be found on the Record of Inspection issued by the inspection agency.Insurer Name Inspector Name Last Inspection Date

This form collects personal information for the purpose of administering activities under Ontario Regulation 220/01, as authorized by the Technical Standards and Safety Act, 2000, S.O. 2000, c. 16.

Date (dd-mm-yyyy) Applicant’s Official Capacity Applicant’s Name Signature

CE 00003 04/19

information, please contact your Insurer.