Petroleum Pipelines Act, 2003 (Act No. 60 of 2003)

Notices

Petroleum Pipelines Act: Rules, 2014

Forms

Form B : Applications for a licence in terms of the Petroleum Pipelines Act, 2003 (Act No. 60 of 2003)

Chapter 1 : General Information
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You are required to provide the following information:

 

Section A: Particulars of applicant

 

1.Full name, where the applicant is a natural person or full registered name of the applicant;
2.Trading name of the applicant (if different from the registered name);
3.Physical and postal addresses of the principal place of business of the applicant;
4.Physical and postal address of the registered office of the applicant (if different from principal place of business);
5.Telephone number of the applicant;
6.Fax number of the applicant;
7.Email address of the applicant; and
8.Details of the mandated representative at the applicant, including:
(a)designation,
(b)family name,
(c)first name,
(d)telephone number,
(e)fax number, and
(f)email address.

 

Section B: Desired commencement date

 

Desired commencement date of the licence applied for.

 

Section C: Additional information

 

Provide any other information relevant to this application.

 

Section D: Licence conditions

 

State your desired licence conditions in terms of section 20(1) of the Act.

 

SECTION E: SOLEMN DECLARATION BY APPLICANT OR MANDATED REPRESENTATIVE

 

I, (full names) .................................................................................................. Identity Number..................................... hereby declare that:

 

(a)I am authorised by ....................................................to make this declaration (attach the authorisation); and
(b)All information provided herein is within my personal knowledge and is both true and correct.

 

 

Signed at ....................................... (place) on this ............ day of ............................................(month) .................................. (year).

 

 

.................................................................

Signature

 

I certify that the deponent:

(a)has acknowledged that she/he knows and understands the contents of this application form and its annexures, that she/he has no objection to taking the prescribed oath and that she/he considers the oath binding on her/his conscience; and
(b)has in the prescribed manner sworn that the contents of this application form and its annexures are true and signed same before me at (place) on this ...............day of .........................................(month) ..................................(year).

 

 

                                                                           

COMMISSIONER OF OATHS

 

Name                                                                                              

 

Address                                                                                      

 

Capacity