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    Annex A - LTO - Refiner, Importer, Bulk Distributor and Terminal Andor Depot OwnerLessor. FNL

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    Leo Cj Palmonis
    The document is an application for a license to operate as a refiner, importer, bulk distributor, terminal owner or depot owner/lessor in the Philippine LPG industry. It requests company and establishment details, the type of application and license being sought, and lists supporting documentation requirements.

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    © All Rights Reserved
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    Annex A - LTO - Refiner, Importer, Bulk Distributor and Terminal Andor Depot OwnerLessor. FNL

    Uploaded by

    Leo Cj Palmonis
    4 views2 pages
    The document is an application for a license to operate as a refiner, importer, bulk distributor, terminal owner or depot owner/lessor in the Philippine LPG industry. It requests company and establishment details, the type of application and license being sought, and lists supporting documentation requirements.

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    Annex A - LTO - Refiner, Importer, Bulk Distributor and Terminal andor Depot OwnerLessor. fnl (1)

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    The document is an application for a license to operate as a refiner, importer, bulk distributor, terminal owner or depot owner/lessor in the Philippine LPG industry. It requests company and establishment details, the type of application and license being sought, and lists supporting documentation requirements.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    4 views2 pages

    Annex A - LTO - Refiner, Importer, Bulk Distributor and Terminal Andor Depot OwnerLessor. FNL

    Uploaded by

    Leo Cj Palmonis
    The document is an application for a license to operate as a refiner, importer, bulk distributor, terminal owner or depot owner/lessor in the Philippine LPG industry. It requests company and establishment details, the type of application and license being sought, and lists supporting documentation requirements.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Republic of the Philippines

    DEPARTMENT OF ENERGY
    Annex A
    September 2022

    Application for Issuance of License to Operate


    Refiner, Importer, Bulk Distributor, Terminal and/or Depot Owner/Lessor

    Date__________________

    Oil Industry Management Bureau


    3rd Floor, PNOC Building 5
    Energy Center, Rizal Drive,
    Fort Bonifacio, Taguig City

    Attention: __________________
    Director

    Dear Sir/Madam:

    In compliance with the Department Circular No. __________________, we wish to inform you of this notice and
    application with details as follows:

    A. Company Details

    1. Company Name :
    2. Business Address
    (Number, Street, Brgy, Mun/City, Province & Region) :
    3. GPS Coordinates (longitude & latitude) :
    4. Telephone Number :
    5. Email Address :

    B. Establishment Details

    1. Establishment Business Name :


    2. Business Address
    (Number, Street, Brgy, Mun/City, Province & Region) :
    3. GPS Coordinates (longitude & latitude) :
    4. Telephone Number :
    5. Email Address :

    C. Application Details

    1. LPG industry participant classification :

    Refiner ( ) Importer ( ) Bulk Distributor ( ) Terminal and/or Depot owner/lessor ( )

    2. Type of application : Original ( ) Renewal ( )

    D. Supporting Documentary Requirements

    Please refer to the documentary requirements in Annexes A-1 to A-6 for compliance.

    E. Compliance to Standards

    The LPG product, Ancillary equipment, actual construction of an LPG facility and code of safety practice
    shall comply with Annex J - List of reference standards/codes based on the latest promulgated PNS or in
    the absence thereof any internationally accepted codes or standards.
    Energy Center, Rizal Drive cor. 34th Street, Bonifacio Global City, Taguig City, Philippines
    1632 Tel. No. (Trunkline) (632) 8479-2900;
    Website: http://www.doe.gov.ph; E-mail: [email protected]
    Very truly yours,

    ___________________________________
    Name, designation & signature of applicant or
    authorized representative

    Reminder/ Instructions:

    1. This application shall be made per company and/or per establishment - facility, plant or outlet;
    2. Submit this application form with complete documentary attachments to OIMB for the issuance of
    License to operate (LTO) before the start of commercial operation.
    3. Pay the application fee based on the order of payment and via bank transfer, postal money
    order/manager's check or actual DOE treasury counter payment payable to the Department of Energy;
    4. Issuance of License to operate shall not be later than twenty (20) working days from receipt of
    application;
    5. OIMB may further require a presentation on the details of application in a pre-application conference; and
    6. Refer to Section 31 of this Department Circular for the DOE handling office of this application.

    ACKNOWLEDGMENT

    REPUBLIC OF THE PHILIPPINES )


    CITY/MUNICIPALITY OF _____________ ) S.S

    BEFORE ME, a Notary Public for and in the City/Municipality of ____________________, this ___ day of
    __________ 20__, personally appeared presenting his/her identification, to wit:

    Name Competent Evidence of Identity Date & Place of Issue

    known to me and to me known to be the same person who executed and voluntarily signed the foregoing
    application, which he/she acknowledged before me as his/her own free and voluntary act and deed, and with full
    authority to sign in that capacity.

    This application consisting of _______ (__) original copy/ies submitted to OIMB with complete attachment , duly
    signed by the applicant.

    IN WITNESS WHEREOF, I have hereto set my hand on the day, year and place above the written.

    NOTARY PUBLIC

    Doc No. ______


    Page No. ______
    Book No. ______
    Series of 20 ______

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