FP.05193.ES-FO.01 Ed.1 Page 1 of 2 1

Connection request for provisional gas supply to perform testing

In their capacity as authorised individual gas installer, Mr/s ………………………… ……………………..…., of legal age, with National ID no. (DNI) ………………………, representing the installation company ……….……………………………….. (hereinafter the “Installation Company”), with registered address at ………………… …...………………………………, which, for the purposes of conducting the tests prior to commissioning, in the installation and/or equipment located at …………… ………...………………………………., with installation power of …….. kW, number of homes ……… and for use ………………………………………… (to be chosen between DHW, heating, air-conditioning and/or testing device per unit),

Hereby declares: I. That s/he is duly accredited and has all the certificates required by current

legislation.II. That s/he has sent the relevant communications to the owner of the

installation and has the authorisation of the same to request a provisional gassupply for testing the installation or equipment.

III. That, in accordance with current legislation, the need for the provisional gassupply to perform the appropriate tests is justified.

Given the foregoing,

S/he requests:

, hereinafter The Distributor, that provide the connection for a provisional gas supply to perform the tests required in the installation or on the equipment in the aforementioned building for a period of 30 days, all in accordance with the liability regime set forth in the current legislation. It will also be provided with the CUPS code so it can contract the gas supply from a marketing company.

Signed by: . The Installer/The Installation Company

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In compliance with the provisions set out in the current legislation on Personal Data Protection,

, informs you that your personal data will be processed for the purpose of managing your request and to comply with the applicable legal obligations. With regards to the communication of your personal data, these may be shared with public bodies and authorities, for compliance with the applicable legal regulations.

You have the right to access, rectify and erase the data, as well as restrict or object to the processing of the same, and exercise your right to the portability of the personal data, at any time, by writing to Claims - Personalised Attention at Plaça del Gas nº 2 - 08003 Barcelona with the reference “Request Data Protection - Nedgia” or to the email address sgestionre@nedgia.es, attaching a copy of your national ID document (DNI/NIE).

We recommend you refer to the detailed information on data protection available on our website https://www.nedgia.es/en/1297078202422/legal+notice.html or request it to be sent to you by email.

The Owner of the Installation ……………………………………………………………... represented by Mr/s ………………………………………………………….., of legal age, with professional address at ………………………………………………… …........, with National ID No. (DNI) ………:………… , and in his/her capacity as …………………………………....., declares that s/he authorises the request for provisional gas.

Signed by: The Owner of the Installation