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

1.

Full registered name of the objector..........................................................................

2.

Trading name of the objector (if different from the registered name)

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3.

Registration number of company (if applicable, or Identity Number if the objector is a natural person)

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4.

Name of mandated representative.  Attach documentary proof of mandate given to representative

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5.

Physical address .......................................................................................................

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6.

Postal address ..........................................................................................................

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7.

Telephone number....................................................................................................

8.

Fax number ...............................................................................................................

9.

Email address ............................................................................................................

10.

Details of contact person at the objector, including:

(a)

designation ............................................................................................

(b)

family name ...........................................................................................

(c)

first name ..............................................................................................

(d)

telephone number .................................................................................

(e)

fax number ............................................................................................

(f)

email address .........................................................................................