Statistics Act, 1999
R 385
Precious Metals Act, 2005 (Act No. 37 of 2005)Precious Metals RegulationsAnnexuresAnnexure C : FormsForm PM REG1 : Registration in the SA Diamond and Precious Metals Regulator’s National Register |
Form PM REG1
South African Diamonds and Precious Metals Regulator
South African Diamond Centre, Cnr Main and Phillip Streets,
Johannesburg. PO Box 16001, Doornfontein, 2028’
REGISTRATION IN THE SA DIAMOND AND PRECIOUS METALS REGULATOR’S NATIONAL REGISTER
Instructions:
| 1. | For any enquiries, contact the office of the Regulator during office hours. |
| 2. | Complete the form in block letters and in black pen. |
| 3. | Where options are given mark the appropriate block. |
| 4. | Complete the form in English and do not use abbreviations. |
| 5. | Although the application forms are made available in electronic format, only a signed original hard copy shall be acceptable. |
| 6. | Ensure that all the required documentation accompanies the application. |
| 7. | The application must be submitted to the operational business premises of the Regulator. |
PART A : PARTICULARS OF APPLICANT
| 1a) | In the case of a natural person, please provide the following: |
| i) | Surname: |
_________________________________________________
| ii) | First name(s): |
_________________________________________________
| iii) | Identity number: |
_________________________________________________
*(A certified copy of the identity document must be attached.)
(b) In case of a person other than a natural person, please indicate:
CC.____________Partnership/Joint venture _____________
Co. ____________Other (specify) _____________________
| i) | Name of company, close corporation, partnership or joint venture: |
_________________________________________________________
| ii) | Registration number of Co. or CC: |
_________________________________________________________
| iii) | Name and identity number of Managing Director, Member: |
_________________________________________________________
| iv) | Type of precious metal/s mined or worked with?: |
_________________________________________________________
_________________________________________________________
_________________________________________________________
*(In the case of a company or close corporation, a certified copy of a certificate of incorporation must be attached.)
| b) | Please provide: |
| i) | Mining right or mining permit number, or the number of the mining authorization which continues in force in terms of the Mineral and Petroleum Resources Development Act, 2002 (Act 28 of 2002), as the case may be. |
| ii) | A certified copy of the mining right, permit or other authorisation, as the case may be, contemplated in c(i). |
PART B: CORRESPONDENCE ADDRESS FOR THIS APPLICATION
| 2a) | Business address: |
| i) | Building name: |
| ii) | Building number: |
| iii) | Street number: |
| iv) | Street name: |
| v) | Suburb: |
| vi) | Town/City: |
| vii) | Postal code: |
| viii) | Province: |
| ix) | Country: |
| x) | Telephone number: |
| xi) | Fax No: |
| xii) | Cellphone No: |
| xiii) | Email address: |
| b) | Relevant postal address: |
| i) | Postal address:_________________________________ |
______________________________
| ii) | Town/City:_____________________________________ |
| iii) | Postal code:____________________________________ |
| c) | Primary Contact Person: |
| i) | Full Name: |
| ii) | Title: |
| iii) | Work Contact Number: |
| iv) | email address: |
| v) | Mobile number: |
PART C: DECLARATION
I, the applicant,___________________________________________________, hereby declare that the contents of this application are true and correct.
Capacity: _
Signed at________________________________on the_________day of_________________
_______________________________________________________
SIGNATURE OF APPLICANT/REPRESENTATIVE (IF APPLICABLE)
[Form PM REG1 inserted by regulation 14 of Notice No. R.387 dated 4 April 2008]
