Schedule 1, Sierra Leone Electricity and Water Regulatory Commission Act 2011,

APPLICATION FORM FOR CAPTIVE ELECTRICITY GENERATION PERMIT Rule 4(a) IMPORTANT NOTE: Your application is not complete unless all requirements herein are received and all questions are answered. 1.0 PARTICULARS OF APPLICANT 1.1 Applicant Information Full Name: __________________________________________ Physical address: __________________________________________ Postal address: __________________________________________ Tel: __________________________________________ Fax: __________________________________________ Mobile Phone: __________________________________________ E- mail: __________________________________________ Website Address: __________________________________________ 1.2 Contact Person Information Full Name: __________________________________________ Physical address: __________________________________________ Postal address: __________________________________________ Tel: __________________________________________ Fax: __________________________________________ Mobile Phone: __________________________________________ E- mail: __________________________________________ 2.0 LEGAL STATUS OF APPLICANT 2.1 Indicate legal status of Applicant (Tick relevant option) Individual Sole proprietorship Partnership Public Limited Private Limited Cooperative Liability Company Liability Company Society Other (please specify): ____________________________________________ (Attach Business registration certificates) 2.2 List and Particulars of Directors: Full Name Address Nationality 3.0 NATURE OF PERMIT 3.1 State whether application is a new application or renewal 3.2 State whether applicant has an existing permit issued by the Commission. 3.3 Has the Applicant ever been denied a permit or had its permit suspended or revoked by the Commission? 3.4 If so, give details of the denial, suspension or revocation 4.0 MAIN BUSINESS ACTIVITIES OF APPLICANT Please indicate the main business activities the applicant is currently engaged in. __________________________________________________ (Please attach a valid Tax Clearance Certificate) 5.0 TECHNICAL CAPACITY Please provide a detailed statement of applicant's technical competence to operate the Power Plant. (Attach CVs of key technical personnel responsible for the operation and maintenance of the plant). 6.0 DESCRIPTION OF POWER PLANT 6.1 State Plant type 6.2 State total capacity of Power Plant 6.3 Location of the Power Plant (Please attach a detailed Schedule of Plant sizes and locations if applying for more than one location) 6.4 Is the Power Plant new? If not, please state number of years the plant has been in operation 6.5 Is the purpose of electricity generation for main supply or standby? (Please note that SLEWRC verify the accuracy of this information) 7.0 TECHNICAL DATA 7.1 Name Plate information and other relevant details: No. of Units and Capacity of each Unit __________________________ Installed Capacity ___________________________________________ Fuel Type _________________________________________________ Rated Power Factor __________________________________________ Plant Load Factor ____________________________________________ Reactive Power Capability ____________________________________ Noise Level (State distance from Power Plant) ___________________ Output Voltage _____________________________________________ Heat Rate _________________________________________________ No. of Phases ______________________________________________ Unit Frequency ____________________________________________ Unit Efficiency ____________________________________________ Date of Installation of Generator _______________________________ Make and Serial Number of Generator __________________________ Date of Manufacture of Generator _____________________________ Technical specification of other equipment ______________________ 7.2 Please provide the following: (For plant size over 1 MW) i. Site-map indicating location ii. Technical details of Generating Set(s) including schematic diagram and brief description of earthing system, protection scheme, etc. iii. Single line diagram of the Power Plant showing the cable sizes and protective devices iv. Environmental Impact Assessment Approval. Where EIA is not applicable, give detailed information on effluents and discharges and how they will be managed. v. Any other details (considered necessary by the applicant) Dated this ________________ day of ________________ 20_________. ____________________________________________________ (Name of Applicant)