For the purposes of section 31(4) of the Act, a certificate in the prescribed form is a certificate that contains the following—
(a) the name of the person who operates the breath analysing instrument;
(b) a statement by the person who operates the breath analysing instrument that they are authorised to operate the breath analysing instrument by the Chief Commissioner of Police;
(c) the serial number of the breath analysing instrument used to conduct the breath analysis;
(d) the sample number;
(e) the location of where the test was conducted;
(f) the name and date of birth of the person whose breath was analysed;
(g) the results of the self-tests conducted using the breath analysing instrument before and after the person's breath was analysed;
(h) the results of zero tests conducted using the breath analysing instrument before and after the person's breath was analysed;
(i) the date and time the person's breath was analysed;
(j) the concentration of alcohol in grams per 210 litres of exhaled air present in the breath sample furnished by the person whose breath was analysed.