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

2.

Full registered name of the applicant........................................................................

3.

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

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4.

Registration number of company (if applicable)  .......................................................

5.

Name of mandated representative (if applicable).  Attach documentary proof of mandate given to representative

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6.

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

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7.

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

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8.

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

9.

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

10.

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

11.

Details of mandated representative, including:

(a)

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

(b)

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

(c)

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

(d)

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

(d)

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

(e)

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