Form 4c - Regulation 38 Statement

Regulation 38 statement
Project Reference e.g. AI/2024/1234 *
Plot Number (if applicable)
I confirm that:

The building work is complete and, to the best of my knowledge, complies with Building Regulations.

I have reviewed the Regulation 38 checklist and fulfilled all my duties under the Building Regulations, including passing the fire safety information to the responsible person*.

The responsible person named below has confirmed to me that the fire safety information I provided is sufficient for them to understand, operate, and maintain the building.
Responsible Person*

*The owner, landlord or occupier of business or other non-domestic premises, will be responsible for fire safety. They are known as the ‘responsible person’.
Name*

First NameLast Name
Company if applicable
Email*
example@example.com
Date of information being passed*

DayMonthYear
Date
Name of person giving declaration*

First NameLast Name
Company if applicable
Email*
example@example.com
Signed*

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Dated*

DayMonthYear
Insert date
The RBCA cannot issue the Final Certificate without receiving these signed declarations.
Should be Empty:

Regulation 38 statement