Malta Resources Authority Tel.

: +356 2295 5101

Millennia Complex Fax.: +356 2295 5200
Triq Aldo Moro Email: [email protected]
Marsa, MRS 9065 www.mra.org.mt
MALTA
APPLICATION FOR REGISTRATION AS A
USER OF A REGISTERED / NOTIFIED Groundwater Source
GROUNDWATER SOURCE – PART I Registration/Notification No.

All sections of this application should be filled in and legible. (Incomplete, illegible or
improperly filled in applications will be delayed or returned).

A bank draft or personal cheque for the amount of € 50 and payable to Malta
Resources Authority must be submitted with this application.

SECTION A - GENERAL INFORMATION

A1. Applicant’s Information

To be filled if application is made by an individual

Title Full Name and Surname

I.D. No./ Passport No: VAT No (if applicable): Trading Licence No: (if applicable):

Contact Address:

Tel. No.: Mobile No. Fax No. E-mail address:

To be filled if application is made on behalf of a Company / Legal Organisation

Name of Company / Legal Organisation

Company Registration No. VAT. No

Trading Licence No. (if applicable)

Type of Company: LTD PLC Corporation Government Organisation

Other (Specify) __________________________________________________________________

Is Company Part of a Holding? YES (Specify) __________________________________ NO

Details of Legal Representative (where applicable)

Title Full Name and Surname:

I.D. No./ Passport No Position Held:

Contact Address:

Tel. No.: Mobile No. Fax No. E-mail address:

MRA/089/v1-04-08/10 Page 1
A2. Users of Groundwater Source – New users
(Fill in on separate sheets if necessary)
Share of use
expressed in
days / annum
NAME &
SURNAME

USER
1 ADDRESS

ID Number

NAME &
SURNAME

USER ADDRESS
2

ID Number

NAME &
SURNAME

USER 3 ADDRESS

ID Number

A2. Existing Registered / Notified users as per Registration of Groundwater Sources

Regulations, 1997 or Notification of Groundwater Sources Regulations, 2008. (where
applicable)
(Fill in on separate sheets if necessary)

NAME &
SURNAME

USER
1 ADDRESS

ID Number

NAME &
SURNAME

USER ADDRESS
2

ID Number

NAME &
SURNAME

USER 3 ADDRESS

ID Number

MRA/089/v1-04-08/10 Page 2
SECTION B - DETAILS OF SOURCE

Address of groundwater source:

Name of land where source is located:

Limits of:

Groundwater Source Registration

/ Notification No.

SECTION C : DECLARATIONS BY THE MAIN APPLICANT AND OTHER USERS

(please also fill in Part II of this form)

I / We (delete where not applicable), understand that the Malta Resources Authority may conduct complete and
comprehensive investigations to determine the accuracy of all information provided in / with this application.

I / We (delete where not applicable), authorise the Malta Resources Authority to make such investigations.

I / We (delete where not applicable) also authorise person/s acting on behalf of the Malta Resources Authority to enter,
inspect and verify any groundwater source and its site notified by this application. I/We (delete where not applicable) also
authorise person/s acting for or on behalf of the Malta Resources Authority to gather and record information regarding such
groundwater source, including by photographic or electronic means.

I / We (delete where not applicable), hereby authorise any person or entity contracted by the Authority to provide any
information as may be reasonably requested by the Authority in connection with this notification.

Main Applicant:

Full Name and Surname: Identity Card / Passport No.

Signed: Date:

ALL Other Users: (If necessary submit additional copies of this sheet with details and signatures of other users as
applicable)

Full Name and Surname: Identity Card / Passport No.

Signed: Date:

Full Name and Surname: Identity Card / Passport No.

Signed: Date:
SECTION E: DECLARATION BY EXISTING REGISTERED USERS AS PER
REGISTRATION OF GROUNDWATER SOURCES REGULATIONS, 1997
OR NOTIFICATION OF GROUNDWATER SOURCES REGULATIONS,
2008. (if applicable)

MRA/089/v1-04-08/10 Page 3
SECTION D : DECLARATIONS BY EXISTING REGISTERED / NOTIFIED USERS

I / We (delete where not applicable), the undersigned, hereby declare that I/we are fully cognisant of this application and its
contents and agree that I/we are knowledgeable of the addition of new users to the groundwater source referred to in this
application.

I / We (delete where not applicable), want to remain / do not want to remain (delete where not applicable), a registered user
of this groundwater source.

All Users: (If necessary submit additional copies of this sheet with details and signatures of other users as
applicable)

Full Name and Surname: Identity Card / Passport No.

Signed: Date:

Full Name and Surname: Identity Card / Passport No.

Signed: Date:

Full Name and Surname: Identity Card / Passport No.

Signed: Date:

PLEASE READ THE FOLLOWING CLAUSE BEFORE SIGNING

DATA PROTECTION CLAUSE

In terms of the Data Protection Act (Chapter 440 of the Laws of Malta), we will process any personal and/ or sensitive data supplied
on/ in this application, request or notification form or subsequently supplied by yourself, whether orally or in writing, for all or any of the
following:
1. The proper processing of your application, request and/or notice as submitted;
2. Preventing, detecting and/or prosecuting fraud and any other criminal activity which the Authority is bound to report
and/or act upon whilst meeting any other specific legal or regulatory obligations;
3. Establishing, exercising or defending any legal action;
4. Internal management, research and statistics, systems administration, the development and improvement of our
services;
5. the protection and promotion of our legitimate interests and the proper conduct of our obligations arising under any law
or statutory instrument; and
6. to make public the necessary information as specified in the relevant law and/or instrument.

Relevant data will be disclosed or shared as appropriate with all our employees and with other third parties if pertinent to any of the
purposes listed above. Every field on the form is mandatory. Should you fail to fill in any mandatory field, we reserve the right to refuse
the application. Should any field be inapplicable to your particular circumstances please mark that field with the letters “N/A”. You
have the right to require that we provide you with access to your personal data as well as the right to rectify, or, in appropriate
circumstances, erase any inaccurate, incomplete or immaterial personal data which is being processed. However, you are required to
inform us immediately of any alterations relating to your personal data which we are processing.

By signing this form, you confirm that you are giving your explicit consent, in terms of the Data Protection Act, on behalf of yourself
and all the other persons specified in this form for the Authority to process your respective personal information as outlined above and
you confirm that you have brought this Data Protection notice to the attention of these other persons and obtained their respective
consents.

We undertake to implement appropriate measures and safeguards for the purpose of protecting the confidentiality, integrity and
availability of all data processed.

MRA/089/v1-04-08/10 Page 4
 Malta Resources Authority Tel. : +356 2295 5101
Millennia Complex Fax.: +356 2295 5200
Triq Aldo Moro Email: [email protected]
Marsa, MRS 9065 www.mra.org.mt
MALTA

APPLICATION FOR REGISTRATION AS A

USER OF A REGISTERED / NOTIFIED Groundwater Source
GROUNDWATER SOURCE - PART II Registration/Notification No.

DECLARATION UNDER OATH (ADMINISTERED BY A COMMISSIONER OF

OATHS) BY USERS OF GROUNDWATER SOURCES

I/We (delete where not applicable), the undersigned

Main Applicant:

Signed: Date:

ALL Other Users: (If necessary submit additional copies of this sheet with details and signatures of other
users as applicable)

Full Name and Surname: Identity Card / Passport No.

Signed: Date:

Full Name and Surname: Identity Card / Passport No.

Signed: Date:

declare that the groundwater source with Registration/Notification No originally

registered / notified by

Full Name and Surname: Identity Card / Passport No.

ALL Previously Registered Users: (If necessary submit additional copies of this sheet with details and
signatures of other users as applicable)

Full Name and Surname: Identity Card / Passport No.

Full Name and Surname: Identity Card / Passport No.

is presently under the effective control and use of the undersigned.

I / We (delete where not applicable), the undersigned accept and understand that the
registration of myself/ourselves as a user of the groundwater source with Registration /
Notification No. does not in any way give the undersigned any right to draw
water from such source, or to dispose of any material, whether liquid or solid, in such source,
or to keep open such source, and the Authority may at any time order the undersigned to
close such groundwater source, notwithstanding that such source is registered / notified and
the relative registration / notification fees have been duly paid. I /we also understand that by
means of the registration as a user of a groundwater source I /we are not in any manner
acquiring or obtaining any vested right with regard to the groundwater source.

MRA/090/v2-02-10/10 Page 1
I / We (delete where not applicable), the undersigned accept and understand that the
registration of myself/ourselves as a user of the groundwater source with Registration /
Notification No. shall in no way prejudice any rights or claims which third
parties may have over such source. I also understand that the acceptance of this application
shall not be construed as conferring or creating any right or presumption in my favour on the
property wherein the groundwater source is situated.

I / We (delete where not applicable), the undersigned, hereby declare that this entire
declaration, all statements, attachments and the other information submitted in connection
with it are true, correct and complete in all respects to the best of my knowledge and belief
and that this declaration is executed with the knowledge that misrepresentation or failure to
reveal information requested may be deemed sufficient cause for the applicable penalties
established by law, and its reporting and use in any criminal action.

Main Applicant:

Full Name and Surname: Identity Card / Passport No.

Signed: Date:

ALL Other Users: (If necessary submit additional copies of this sheet with details and signatures of other
users as applicable)

Full Name and Surname: Identity Card / Passport No.

Signed: Date:

Full Name and Surname: Identity Card / Passport No.

Signed: Date:

DETAILS OF COMMISSIONER OF OATHS

Full Name

Signature

Official Stamp Date

MRA/090/v2-02-10/10 Page 2