SCHEDULE II
[see clause 5(1)]
Application form
(for issue of authorization to market Motor Sprit and High Speed Diesel)
To,
The Joint Secretary,
Ministry of Petroleum and natural Gas,
Government of India, Shastri Bhawan,
New Delhi-110001
1.0 Name of applicant
2.0Type of firm (strike out whichever is not applicable)
2.1 Public Limited Company/Private Limited Company/Partnership firm/Proprietorship firm/Othersv
3.0 Address
3.1 Registered office
4.0 Names, address, telephone numbers of Directors/Partners/Proprietor.
5.0 Detail of investment made and/or proposed to be made in eligible activities along with completion schedule of the project for new and incomplete projects-
(i) setting up new grass root refineries and/or expansion of the existing refineries along with facilities like crude oil receipt and transportation facilities.
(ii) Exploration and production of hydrocarbons including coal bed methane, and associated facilities like crude oil/natural gas pipelines, crude oil natural gas processing plants.
(iii) Terminals for crude oil/LNG.
(iv) Common carrier natural gas/petroleum products/LPG pipelines;
(v) Investment in the above activities for setting up additional assets for improvement in quality of product to meet environmentally related norms.
Note:- The activities other than those specified would not be eligible.
6.0 Time for the completion of new and incomplete projects to be indicated with completion date.
7.0 Details of scheme of marketing-
(i) the source of supply of product to be marketed;
(ii) tankage and other infrastructure established/proposed to be established alongwith their capacity;
(iii) means of transportation of products to depots and retail outlets
(iv) the number and location of retail outlets proposed top be established and details of their storage and dispensing capacity
(v) the total quantum and type of products to be covered under the marketing scheme.
Note:- Details on the above may be separately attached.
8.0 The mode of compliance relating to retail service obligation and marketing service obligations.
(i) number of retail outlets proposed to be set up in remote areas/low service areas.
(ii) other marketing infrastructure proposed to be set up in remote areas /low service areas.
(iii) Commercial agreements proposed, if any, with the existing marketing companies.
(iv) Others(please specify)
9.Detail of application fee paid.
10. Decleration
Certified that the above information is true to the best of my knowledge and belief and the information as annexures and statements accompanying this application are correct, complete and truly state and if any statement made herein is to be incorrect, I shall be liable for action under the provisions of law.
Date:_________
(Signature) Name:_________________
Designation:____________