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Petroleum Pipelines Act, 2003 (Act No. 60 of 2003)

Notices

Petroleum Pipelines Act: Rules, 2014

Forms

Form F : Application for the revocation of a licence in terms of section 24 of the Petroleum Pipelines Act, 2003 (Act No. 60 of 2003)

Section C : Solemn declaration by the person willing and able to assume the rights and obligations of the licensee or mandated representative

 

 

I, (full names)  ............................................................................................ Identity Number, ..........................................................., hereby declare that:

 

(a) I am authorised by ........................................................................ to make this declaration (attach the authorisation); and

 

(b) all information relating to ............................................ provided herein is within my personal knowledge and is both true and correct;

 

(c) ................................................................... is willing and able to assume the rights and obligations of the Petroleum Pipelines Act, 2003 (Act No. 60 of 2003); and

 

(d) ................................................................... will apply for the relevant licence.

 

 

Signed at  ....................................... (place) on this ............day of ......................................(month) .......................(year).

 

 

...............................................................

Signature

 

I certify that the deponent:

(a) has acknowledged that she/he knows and understands the contents of this application form and its annexures, that she/he has no objection to taking the prescribed oath and that she/he considers the oath binding on her/his conscience; and
(b) has in the prescribed manner sworn that the contents of this application form and its annexures are true and signed same before me at ............................................................... (place) on this .............day of ............................................ (month)  ................................ (year).

 

 

                                                                                 

COMMISSIONER OF OATHS

 

 

Name                                                        

 

Address                                                          

 

Capacity