For the purposes of section 32(4) of the Act, a certificate in the prescribed form is a certificate that contains the following—
(a) a statement by the approved analyst that the person is an approved analyst within the meaning of section 32(1) of the Act;
(b) a statement as to the concentration of alcohol found in the blood sample;
(c) a statement as to the method of analysis used;
(d) the information set out on the identification label referred to in regulation 10(1)(d) that is attached to the container in which the blood sample is placed;
(e) the date on which the analysis was conducted;
(f) the name and signature of the approved analyst.