FORM D

[See Rule 114 (2)]

Application for the grant/ renewal of a licence to store or to import and store petroleum
The replies to be written in this column

1. Applicant’s Name
‘’ Profession

“ Address

2. Situation of the Premises where petroleum

is to be stored

District

Town or Village
3. Petroleum Proposed to be stored –
Nature (i.e. dangerous, non-
dangerous or heavy petroleum)
In Bulk
Quantity
Not in Bulk

4. Form in which licence is required

5. Do the premises fulfil all the conditions
endorsed on the Form?
6. Petroleum already stored on the premises –
Nature
In Bulk
Quantity
Not in Bulk

7. Dangerous Petroleum proposed to be

imported –
In Bulk
Quantity
Not in Bulk

Remarks

Signature of the
Applicant
Postal Address of
the Applicant
Date of
Application

NOTE –This application if it relates to a new installation or storage shed or if the applicant proposes any alterations in an existing
installation or storage shed, must be accompanied by specifications and plans drawn to scale in duplicate. The plans should
clearly indicate:-
(a) The manner in which the conditions prescribed by these rules have been complied with;
(b) The premises to be licensed, the area of which shall be distinctively coloured or otherwise defined;
(c) The surrounding and all protected works;
(d) The position and capacity of all storage tanks, storage and filling sheds and the position of all other buildings and
erections forming part of the installation;
(e) The areas reserved for dangerous petroleum, heavy petroleum and non-dangerous petroleum other than heavy
petroleum;
(f) Tanks and other enclosures;\all pumps, valves fittings and discharge points, vent pipes, etc.
*In case where the application is made on behalf of a company, the name and address of the company and the name of the
manager or agents should be given.
S. (Agency) 62.
PCPPK–H/3457/69/(D.C.S.&F.)–23-1-70–10,000.