Schedule 2, Commission (Mini Grid ) Regulations, 2019

Regulation 8 (1) (b) Application form for full mini-grid licence IMPORTANT NOTES: Your application is incomplete unless all required documents are submitted. SLEWRC reserves the right to verify the accuracy of this information. The full mini-grid licence, if approved by SLEWRC Commission, will be valid for a duration up to twenty (20) years and may be renewed or extended by the Commission beyond that time following procedure described in the Regulations. In compliance with the SLEWRC Mini-Grid Regulations, 2019I............[name of representative] certify that, [name of company] ............................................. isintending to construct, install and/or start to operate a mini-grid system for the provision of electricity on [date] ........................, and hereby applies to register theproject as a mini-grid for a full mini-grid licence pursuant to the SLEWRC Mini- Grid Regulations, 2019. 1.0 PARTICULARS OFAPPLICANT AND CONTACT PERSON Name of applicant:.............................................................................................................. Physical address:................................................................................................................ Postal address:..................................................................................................................... Tel:........................................................................................................................................ Fax:.......................................................................................................................................... Mobile phone:..................................................................................................................... E-mail:................................................................................................................................... Website address:................................................................................................................. Name of contact person:................................................................................................... Mobile phone of contact person:..................................................................................... E-mail of contact person:.................................................................................................... 2.0 LEGAL STATUS OFAPPLICANT 2.1 Indicate legal status of applicant (tick relevant option) A. Sole proprietorship B. Partnership C. Company Limited by Shares (Private) D. Company Limited by Shares (Public) E. Cooperative society F. Other (please specify) 2.2 List and particulars of directors: Name Nationality Address Expiry date of tenure 3.0 NATURE OFAPPLICATION 3.1 State whether application is a new application. 3.2 Existing Licence Does the applicant have an existing basic or full mini-grid licence issued by the commission for other systems? If yes, state the nature of the licence, date issued and the licence. 3.3 Refusal, Suspension or cancellation of licence Has the applicant ever been refused a licence or had its licence suspended and/or cancelled by the Commission? If yes, give details of the refusal, suspension, and/or cancellation. 4.0 MAIN BUSINESS ACTIVITIES OFAPPLICANT Please indicate the main business activities the applicant is currently engaged in. 5.0 DESCRIPTION OF PROJECT Detailed description of the project: 5.1 Site of the mini-grid Village:.............................. Ward:...................... Chiefdom:...................... District:.............. 5. 2 Generation Solar .................kW Wind .................kW Generation Biomass .................kW Hydro .................kW Diesel .................kW other: .................kW Total: .................kW Storage ................. .............. kWh Inverters ................. .............. kWh Terminal Voltage .................v Rated Frequency .................Hz Expected Annual .................kWh/year Generation (kWh/year) Location of the power plant (geographical coordinates / GPS): Is the power plant new? If no, please state number of years the plant has been in operation. If yes, please state the expected date of commissioning. 5. 3 Distribution Three-phase MV ........... metres Lines Single phase LV ........... metres Three-phase LV ........... metres Total: ........... metres Type of Lines Overhead Underground Concrete ............... poles Wood ............... poles Poles Steel ............... poles Other: ................. ............... poles Total: ............... poles Transformers ............... type ............... number ............... kVA Length of distribution network (indicate geographical coordinates of four reference points) 5.4 Consumers Number of consumers: Residential:.............................. Commercial:.............................. Productive/Industrial:.................... Health Centres:........................... Schools:............................. Street lighting:............................ Other (please specify): ................................................... 5.5 Electricity sales Expected electricity sales [kWh/year]: 6.0 DECLARATION BY THE APPLICANT The project is not unlawful or contrary to the interest of Sierra Leone, the National Electricity Act, 2011, the SLEWRC Act, 2011 and relevant SLEWRC Regulations. I/ we hereby declare that the details stated above are, to the best of my/our knowledge, true and correct. Dated this..................... day of ........................................... 20................ THE COMMON SEAL OF THE WITHIN NAMED APPLICANT Name of Applicant Signature Has hereunto been affixed in the presence of: Sign: Sign: Name: Name: Designation: Designation: Sworn to this...................... day of..............................................................20............at 72 73 FOR OFFICIAL USE ONLY Date of submission of application:..................................................................................... Fees paid and receipt Number:......................................................................................... Results of verification for completeness:....................................................................... Recommendation of SLEWRC Legal Division: .............................................................. Recommendation of SLEWRC Head of Electricity: ...................................................... Decision of SLEWRC:........................................................................................................ Issue date of licence: ......................................................................................................... Expiration date of licence: ................................................................................................... Other relevant information: ............................................................................................. ACCOMPANYINGDOCUMENTATION 1. Completed application Form 2. MoU between proposed mini-grid developer and GoSL / site confirmation from Ministry of Energy 3. Power station layout drawings 4. Map with position of power station and distribution network marked using indicators to distinguish single phase and three phase as well as medium voltage networks 5. Certified copy of certificate of incorporation, 6. Memorandum and articles of association, deed of partnership or deed of trust (as applicable), 7. Tax & NASSIT registration certificates 8. Agreement for land occupancy or land lease for project site 9. Environmental Protection Agency (EPA)permit, permission, licence, approval or similar document or confirmation for exemption as is required by EPA for this project 10. Signed health and safety guidelines 11. Financing Agreements 12. Business Plan or Feasibility Study outlining among others the operational concept 13. Work plan