Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1696586370219.pdf (Vanuatu)
APPLICATION FORM: RENEW A LICENCE TO HANDLE CONROLLED SUBSTANCES Department of Environmental Protection and Conservation www.environment.gov.vu Private Mail Bag 9063 Port Vila, Vanuatu Phone: (678) 33430 VOIP: 3893 Email: ozone@vanuatu.gov.vu How to complete this application form This application form and any supporting information provided with it are to renew your Licence to Handle Controlled Substances under the Ozone Layer Protection Act No.
22 of 2019 (the OLP Act) and the Ozone Layer Protection Regulation (the OLP Regulation).

Licences to Handle Controlled Substances are valid for two years from the date of issue and may be renewed.

If you want to renew your Licence to Handle Controlled Substances, you must apply to the Director of the Department of Environmental Protection and Conservation (the Department) before your licence expires.
If you do not renew your Licence to Handle Controlled Substances before your licence expires, you will need to submit a new application (i.e., an Application for a Licence to Handle Controlled Substances).

Payment of application fees: applications to renew a Licence to Handle Controlled Substances requires payment of a 5,000 vatu application fee (excluding VAT).

This fee is provided for in the OLP Regulations.


Application fees must be paid at the government cashier at the Department of Finance and Treasury.

We do not accept payments at our offices.

Please take the attached invoice to the government cashier for payment.

A receipt from the government cashier must be attached to this application form when it is submitted to the Department.

Your application will not be processed until you provide us with a copy of the receipt from the government cashier.
YOU MUST NOT HANDLE CONTROLLED SUBSTANCES BEYOND THE EXPIRY OF YOUR CURRENT LICENCE TO HANDLE CONTROLLED SUBSTANCES UNLESS AND UNTIL YOUR LICENCE TO HANDLE CONTROLLED SUBSTANCES IS RENEWED BY THE DEPARTMENT OR A NEW LICENCE IS GRANTED.

Page 1 of 6 Approved Form: Renew a Licence to Handle Controlled Substances: VERSION 2020_01E 1.

APPLICANT Full name of applicant Contact details Physical address: Mailing address: Tel: Current employer Mobile: Email: Registered business or company.
Please specify the name of the registered business or company.

* The name of a registered business could be the name of an individual.

Charitable association Please specify the name of charitable association.

Government department or agency Please specify the name of the department or agency.

Other organisation Please specify the name and nature of the organisation.
Current employer’s contact details If you are self-employed and have provided your contact details above, you do not need to repeat them here.

Physical address: Tel: Mobile: Email: Page 2 of 6 Approved Form: Renew a Licence to Handle Controlled Substances: VERSION 2020_01E 2.

LICENCE INFORMATION This form is to renew an existing Licence to Handle Controlled Substances.

To assess your application, we need know about your current Licence to Handle Controlled Substances.
NOTE: the maximum time for which a Licence to Handle Controlled Substances may be extended is two years.

Licence to Handle Controlled Substances What is your current licence number?

3.

SUITABILITY To approve your application the OLP Act requires the Director to be satisfied about several matters.

This section addresses these matters.

Y/N Yes No Yes No Yes No Yes No Yes No Suitability question Have you ever been issued a penalty notice under the OLP Act?
Have you ever been convicted of an offence against the OLP Act?

Have you ever been issued a penalty notice or convicted of an offence under another Act where that offence involved controlled substances or manufactured products?

For example, an offence under the Customs Act No.

7 of 2013 or an offence under the Energy Efficiency of Electrical Appliances, Equipment and Lighting Products Act No.

24 of 2016.

Do you have the necessary skills or trained staff to minimise emissions of controlled substances?
If you and/or your staff hold a licence to handle controlled substances or a trainee licence to handle controlled substances, please mention this here.

If not, please provide a summary of your relevant qualifications and training and the qualifications and training of your staff that will be handling controlled substances.

Use additional sheet(s) if required.

Do you have or have access to the necessary equipment to minimise emissions of controlled substances?
Please describe the equipment you will use to minimise the emission of controlled substances into the atmosphere.

For example, vacuum pumps, pressure gauges, leak detectors, recovery machines etc.

Please indicate whether this is your equipment or not.

Use additional sheet(s) if required.

Please provide details Page 3 of 6 Approved Form: Renew a Licence to Handle Controlled Substances: VERSION 2020_01E Page 4 of 6 Approved Form: Renew a Licence to Handle Controlled Substances: VERSION 2020_01E 4.
DECLARATION If you are the applicant: By signing this application, I____________________________________________________________ 1.

Declare I am/we are the holder of the Licence to Handle Controlled Substances the subject of this application.

2.

Declare all the information presented herein and attached is true and correct.
Applicant’s signature: Date: _____________________ ANY RENEWAL OF YOUR LICENCE TO HANDLE CONTROLLED SUBSTANCES WILL BE PRIMARILY BASED ON THE DESCRIPTION YOU HAVE PROVIDED ON THIS FORM.

THIS APPLICATION IS TO RENEW A LICENCE TO HANDLE CONTROLLED SUBSTANCES UNDER THE OZONE LAYER PROTECTION ACT ONLY.

THE GRANTING OF A LICENCE UNDER THE OZONE LAYER PROTECTION ACT DOES NOT INFER OR ASSUME THE GRANTING OF LICENCES, PERMITS OR OTHER APPROVALS UNDER ANY OTHER VANUATU LEGISLATION.

5.
5.

OFFICIAL USE ONLY Application received by: Name: Position: Date application form received: Page 5 of 6 Approved Form: Renew a Licence to Handle Controlled Substances: VERSION 2020_01E How to pay your Licence to Handle Controlled Substances renewal application fee The Department does not accept payments at the office at Nambatu or Luganville.

Please: Insert your name into this invoice 1.

2.


Take this invoice and pay your application fee to the government cashier at the Department of Finance and Treasury 3.

Attach a copy of the receipt provided by the government cashier to your application to renew your Licence to Handle Controlled Substances.

______________________________________________________________________ CT No.
108434 Name of applicant: Description of Fee INVOICE Work Description Amount (VUV) Item 643: Ozone Fees Application to renew a Licence to Handle Controlled Substances VAT INVOICE TOTAL 5,000 750 5,750 Page 6 of 6