SCHEDULE Form No. 1 (Regulations, 8,9,10,11,12,13,14) APPLICATION FORM FOR A LIQUEFIED PETROLEUM GAS (LPG) LICENCE (A separate application form must be completed in respect of each separate business establishment) 1. Name of business/applicant 2. Details of applicant: a) Income Tax Personal Identification Number(s) b) Postal address c) Location of business premises: Plot No Building Name Street/Market Town/District
3. Give full details of proprietors or partners owning business or directors/shareholders of the company, as the case may be. Name Nationality (Where applicable No. of shares held) (any additional information should be submitted on a separate sheet of paper.) 4. Full description of the LPG activity for which the licence is required. 5. (a) Indicate the number and date of issue of any licence previously held under the Act. 6. State if you are or any of your partners/directors is an undischarged bankrupt. (If so indicate the names.) 7. (a) Has any previous application for a licence been rejected under the Act? (If so, give details)
(b) Has any previous licence been cancelled under the Act? 8. (a) Certified copies of the following documents should be submitted with the application for a licence: (i) (ii) (iii) (iv) (v) (vi) (vii) If the applicant is a Kenyan, a copy of both sides of ID card or if a non-kenyan current work permit together with copies of pages 1 and 5 of the passport; Relevant entry permit(s) for non-citizens; Either copies of Business name Registration Certificate or Certificate of Incorporation and Memorandum and articles of Association in case of a company (whichever is applicable); Lease agreement or letter from landlord confirming tenancy. PIN and VAT certificates. Tax compliance certificate Any other document which may be requested by the commission from time to time. (b) An applicant for renewal of a licence shall submit only a photocopy of the current Licence and evidence of activities using the previous Licence 9. CONDITIONS FOR A LICENCE FOR LPG BUSINESS ACTIVITIES. a) MINIMUM OPERATIONAL STOCKS Companies importing petroleum products for marketing in Kenya shall maintain 20 days minimum operational stocks of liquid petroleum products and 10 days stock of LPG. b) SUBMISSION OF SALES DATA Companies marketing petroleum products in Kenya shall submit monthly sales data. DECLARATION i. I/We have read and understood the relevant sections of the Energy Act, No. 12 of 2006 and the legal notice No 121 dated 2 nd, July 2009.and agree to abide with them. ii. iii. I/We hereby certify that the information given above is to my/our knowledge true and accurate. I/We understand that it is an offence to give false information in an application for a licence.
iv. I/We understand that any person or company found diverting export petroleum products to the Kenyan market, either directly or indirectly shall have the their licence revoked. v. I/We understand that I/We should conduct an honest LPG business. vi. Name I/We hereby confirm that our Company/Business shall abide by the terms and conditions of the LPG Cylinder Exchange Pool Agreement.. of Company: Name and ID of Person signing The Declaration: Designation and telephone No.: Signature & Stamp: Date: FOR OFFICIAL USE ONLY 1. Date application received: 2. Date of meeting of Petroleum Licencing Committee: 3. Decision of Petroleum Licencing Committee. Members present: Signature 1. 2. 3. 4.
(a) If application is deferred or rejected, date of letter advising applicant accordingly. 4. Date of review of application Decision of Committee Members present: Signature 1. 2. 3. 4. 4. Licence details No. Date issued Expiry date
THE ENERGY ACT, 2006 QUESTIONNAIRE TO BE FILLED BY NEW APPLICANTS FOR LPG BUSINESS LICENCE 1. Name of applicant: 3. Nature of business (Sole Trader, Partnership, Private Company or Public Company): 4. Certificate of Incorporation/Registration Number and date: Country of Incorporation: Physical address: Postal address: Telephone/ fax: Email address: 5. Give particulars of proprietors or partners or directors/shareholders of Company as may be the case. Name Nationality Shares (if applicable) 6. Give details on equity capital including other sources of financing 7. Indicate bank references 8. Type of business required to be licensed (tick as appropriate): (i) Refining.
(ii) (iii) (iv) (v) (vi) (vii) Importation. Exportation. Wholesale. Storage. Transportation. Specify any other. (a) 9. Indicate if you (a) Own storage facilities (If so, give details including location and capacity) (b) Have hospitality/rental arrangement (If so, give details including copies of any agreements) 10. Do you intend to market your product locally? If Yes, (a) Give the number and locations of Retails Outlets (b) Give the number and locations of Distribution Depots including their capacities (c) If neither (a) nor (b) is applicable, explain (See Addendum for terms and conditions to be met by companies intending to import petroleum product for the Kenyan market) 11. Give details on how you propose to maintain the approved quality of your product 13. Give details of measures you have taken/you propose to take to ensure that the product you handle does not endanger life or pollute the environment
14. Any additional information that the applicant wishes to give (If space provided above is not adequate use plain paper where applicable and attach to this questionnaire) Name of Company: Name and ID of Person signing The Declaration: Designation and telephone No.: Signature & Stamp: Date:
LICENCE EVALUATION CRITERIA FOR LPG BUSINESSES. Criteria IMP TYPE OF LICENCE EXP STO FIL WH- CYL WH BULK RET TP CEP Application form LPG No. 1 Yes Yes Yes Yes Yes Yes Yes Yes Yes Detailed Questionnaire Yes Yes Yes Yes Yes Yes Yes Yes Yes Certified copies of Certificate of Incorporation Yes Yes Yes Yes Yes Yes Yes Yes Yes Certified copies of PIN registration certificate Yes Yes Yes Yes Yes Yes Yes Yes Yes Certified copies of VAT registration certificate Yes Yes Yes Yes Yes Yes Yes Yes Yes Certified copies of Current Tax compliance certificate Yes Yes yes yes yes yes yes yes yes Certified copy of Lease agreement Yes Yes Yes Yes Yes Yes Yes Yes Yes OSMAG membership Yes Yes Supply agreement with licensed importer or wholesaler Yes Yes yes Yes Yes Letter from supplier to ERC Yes Yes Yes Yes Yes Yes Yes EIA Licence (if new) Yes Yes Yes Yes Letter of compliance with environmental regulations from NEMA (if existing) Yes Yes Yes Yes Certified copy of Certificate of compliance with physical planning Act Yes Yes Yes Yes Clearance certificate form chief fire officer Yes Yes Yes Yes Yes Detailed approved drawing drawn to scale Yes Yes Yes Yes DOHSS certificate Yes Yes Certificate of ownership of cylinders/authorisation letter from cylinder owner Yes Yes Yes Authority from cylinder brand owner yes yes Yes Certificate of scale calibration (W&M) Yes Yes Yes Yes Yes Yes Membership of LPG Cylinder Exchange Pool Yes Yes Yes Certificate/proof of compliance with Kenya Standards Yes LPG Handlers basic knowledge/training certificate Certificate of compliance with Kenya standards on LPG vehicles Yes Valid vehicle inspection certificate from MVI Yes Driver basic training Driver certification as per section 80(4) Driver experience 4 years for bulk and 2 years for cylinder trucks Yes Driver health certificate Yes Driver Valid driving licence Yes KEY IMP Import STO Storage WH CYL Whole sale of cylinders RET Retail CEP Cylinder exchange pool EXP Export FIL Filling WH BULK Whole sale of Bulk TP Transport