WASTE COLLECTION PERMIT APPLICATION FORM …

1 Version QF 23(a) Version 16/03/2016 WASTE COLLECTION PERMIT APPLICATION form Guidan ce Not es & Appl ication F orm For Both New & Re view WASTE C ollect ion PERMIT Applic ations Applicant Name: Telephone Number: Postal Address: form 1 IN ADDITION TO THIS form , PLEASE ENSURE TO COMPLETE AND INCLUDE: form 2: WASTE Codes Table (Excel File) form 3: Supplementary Questions (applicable for specific WASTE types only, see Question of this form ) form 4: Household Kerbside WASTE Service and Vehicles Table (Excel File) ALL FORMS ARE AVAILABLE TO DOWNLOAD FROM IMPORTANT Please note this APPLICATION form is continuously updated. If this form has not recently been received or downloaded, you are advised to contact the National WASTE COLLECTION PERMIT Office to confirm that this is the most recent version.

2 Please be aware that information supplied in this APPLICATION , including supporting documentation, will be put on public display and open to inspection by any person. Following the APPLICATION process your APPLICATION may be made available under the Freedom of Information Act 2014 i QF 23(a) Version 16/03/2016 Checklist of Information to be Supplied with APPLICATION INFORMATION REQUIRED: QUESTION INCLUDED One fully completed APPLICATION form ONLY. All questions to be completed or marked not applicable . All Confirmation of payment of APPLICATION fee : receipt number/copy of EFT payment. An original Statutory Declaration form (Appendix 1). Signed by either sole trader, each partner or director where applicable. Completed WASTE Codes Table (Excel file please download from ) One electronic copy to be submitted.

3 Appendix 6 completed for each facility that is intended to be used in connection with the WASTE COLLECTION activity. A copy of the Vehicle Registration Certificate for each vehicle. A copy of current Tax Clearance Certificate from Irish Revenue. An original Financial Declaration form (Appendix 3). An original Motor Insurance Declaration form (Appendix 4). An original Public Liability Insurance Declaration form (Appendix 5). For new applications : A copy of the relevant page from the newspaper(s) in which notice(s) have been published. (Template in Appendix 2). Appendix 2 IF APPLICABLE PROVIDE THE FOLLOWING: QUESTION INCLUDED A copy of Notice from nominated authority instigating a review. A copy of Certificate of Registration of Trade Name. A copy of the printout from the Companies Registration Office detailing the Company Directors.

4 A copy of the applicant s Certificate of Incorporation issued by the Companies Registration Office. Supplementary Questions as may be required. For Household Kerbside WASTE form 4 (excel spreadsheet of proposed household WASTE COLLECTION service and vehicles). Supplementary A Draft Customer Charter (For Household Kerbside WASTE Only) Supplementary FP2 form for the export of WASTE outside of the Island of Ireland (Port of export). A copy of the documentation specified by the NWCPO for the leasing of vehicles or the sub-contracting of WASTE COLLECTION . ii QF 23(a) Version 16/03/2016 IF APPLICABLE PROVIDE THE FOLLOWING: ( ) QUESTION INCLUDED Details of any court hearing, case, nature of the offence and any penalty or requirements imposed by the court.

5 Where the applicant is a sole trader or partnership, include details of any such conviction where any relevant person or partner was at any time within the last 10 years prior to this APPLICATION , a director, manager, company secretary or similar officer for a company. Fees payable from 16th January 2016 APPLICATION Fees: Fee amount paid: Payment type: (cheque, EFT, cash) Electronic Funds Transfer reference number, where applicable: NEWSPAPER CHECKLIST IMPORTANT INFORMATION Applicants are hereby advised that in accordance with Article 6 (1)(b) of the WASTE Management ( COLLECTION PERMIT ) Regulations 2007-2016 the NWCPO may now publish notification of the intention to make an APPLICATION on the website of the NWCPO, Applicants wishing to avail of this option, rather than having their public notice published in a newspaper, are advised to contact the NWCPO.

6 APPLICATION TO OFFALY COUNTY COUNCIL AS NATIONAL WASTE COLLECTION PERMIT OFFICE (NWCPO), FOR A WASTE COLLECTION PERMIT RELATING TO A WASTE COLLECTION ACTIVITY OR WASTE COLLECTION ACTIVITIES IN (<<NAME REGION OR REGIONS>>) Full name and address of principal place of business of the applicant. State that the APPLICATION for a WASTE COLLECTION PERMIT will be made to the NWCPO within 10 working days of the newspaper notice. Specify the nature of the WASTE COLLECTION activity to which the APPLICATION relates (or use template as provided in Appendix 2) and the local authority area or areas where the COLLECTION activity or activities will be undertaken. State that a copy of the APPLICATION will be available for inspection or purchase at the principal offices of the Local Authorities from as soon as is practicable after receipt by the NWCPO.

7 APPLICATION Completed By: _____ _____ Signature BLOCK CAPITALS QF 23(a) Version 16/03/2016 Table of Contents Checklist of Information to be Supplied with APPLICATION i 1. GUIDANCE NOTES 1 Introduction 1 Who Do I Apply To? 1 Fees Payable from 16th January 2016 2 Pre- APPLICATION Research and Consultation 2 Guidance on the APPLICATION form and Process 3 Additional Documentation to be Included 3 About these Guidance Notes 4 2. APPLICATION GENERAL INFORMATION 5 APPLICATION Type 5 Consultant / Agent Details 5 Pre- APPLICATION Consultation with the NW CPO 5 3. EXISTING PERMIT HOLDER DETAILS 6 Existing PERMIT (s) Held by the Applicant 6 Reason(s) for the Review of Existing Permits 6 4.

8 ABOUT THE APPLICANT 7 Applicant s Correct Legal Entity 7 Full Name of Applicant(s) 7 All Business Name(s) (Trade Names) Used, or Proposed to be Used 8 Applicant(s) Contact Details 8 The Local Authority Area where the Principal Office is Based 8 Statutory Declaration 8 Is the Applicant a Company? 9 Is the Applicant a Partnership / Joint Applicant / Limited Liability Partnership? 9 5. ABOUT THE WASTE COLLECTION ACTIVITY 10 WASTE COLLECTION Areas 10 General W aste Activity 11 WASTE Type and Description 11 Supplementary Questions for Specific W aste Types 12 WASTE Destination Facilities within the Island of Ireland (including Northern Ireland) 13 Facilities Outside of Ireland TransFrontier Shipment (TFS) 13 WASTE COLLECTION Vehicles 14 QF 23(a) Version 16/03/2016 6.

9 FIT & PROPER PERSON REQUIREMENTS 16 Relevant Convictions 16 Regional W aste Plan and/or National Hazardous WASTE Management Plan requirements 16 Technical Competence (Fit and Proper Person) 17 Record Keeping and Reporting 18 Financial Commitment Discharge 18 Insurance Details 19 Environmental Liability 19 Revocation of a W aste COLLECTION PERMIT 19 7. ADDITIONAL INFORMATION 20 Appendix 1 - Statutory Declaration 22 Appendix 2 - Suggested Newspaper Notice Format 23 Appendix 3 - Financial Commitment Discharge Declaration 25 Appendix 4 - Motor Vehicle Insurance Declaration 26 Appendix 5 - Public Liability Insurance Declaration 28 Appendix 6 Inclusion of an Authorised WASTE Facility 30 NWCPO WASTE COLLECTION PERMIT APPLICATION form Version Section 1 - Guidance Notes 1 QF 23(a) Version 16/03/2016 1.

10 GUIDANCE NOTES Introduction On the 1st of February 2012, Offaly County Council was designated as the Nominated Authority for the processing of all new WASTE COLLECTION PERMIT applications and Review applications . This single Nominated Authority is known as the National WASTE COLLECTION PERMIT Office (NWCPO). This form is for making an APPLICATION for a WASTE COLLECTION PERMIT under the WASTE Management ( COLLECTION PERMIT ) Regulations No. 820 of 2007 as amended (hereafter referred to as the Regulations). This APPLICATION form can be used to apply for a: New/Review single Local Authority Area WASTE COLLECTION PERMIT ; or New/Review single region WASTE COLLECTION PERMIT ; or New/Review multi region WASTE COLLECTION PERMIT . The APPLICATION form and other relevant documents are available to download from the NWCPO web site In order to make the APPLICATION process as efficient as possible, it may be necessary for the NWCPO to contact the applicant or a representative for the applicant while processing the APPLICATION .