P.O. Box 5250 Majorstuen
NO-0303 Oslo
Application for financial support to NOx reducing measure from the
Business Sector’s NOx Fund, Norway
All information requested in this form shall be filled in to the extent it is relevant for the
specific measure and the company. An incomplete application will get longer handling time,
or it may risk not being handled at all.
Applicant information
Company name
Organisation number:
Postal address
Postal code
City
Country
Contact person
Telephone no.
Mobile phone no.
E-mail address
Ship/plant information
Name of ship, rig or
plant:
IMO number
(for ship/rig)
☐ The ship/rig has signed contract for
operation until………..
Type of ship/plant
Year built
Other information about contract:
Has the applicant's ship/rig/plant previously been grated support from the NOx Fund?
☐ NO, the object has not previously been granted support
☐ Yes, but the measure has not/will not be carried out
 The NOx Fund's reference number:
☐ Yes, the following measure is/will be carried out with support from the NOx Fund
 The NOx Fund's reference number:
Application form 18.8.2015
1
Information about combustion units relevant for the measure
Provide the following information for each different relevant combustion unit:
 Type of combustion unit (e.g. main engine, auxiliary engine, boiler, turbine)
 Power (kW or other capacity unit)
 Engine speed – rpm (for engines only)
 Producer/brand and type (for engines only)
 Number or equal units
 Type of fuel (HFO, MDO, MGO, LNG, electricity, other to be specified)
In case of measures on existing ship/plant where an old unit is replaced with a new,
information shall be provided for both the old and the new unit.
Information can be provided in the table below (add rows according to needs) or enclosed to
this application.
Unit type
Power
rpm
Producer/type
# units
Fuel type
Information about the NOx reduction measure
Brief description of the measure. Supplier offer and other information can be enclosed.
Name of supplier
(yard/builder)
Application form 18.8.2015
Name of measure technology
supplier
Estimated completion date of
measure
2
Energy consumption for ships/plants where the measure is installed
Last 3
yrs.*
Total fuel
consumption
leading to taxed
and non-taxed
NOx emissions
(ton/yr)
Fuel consumption
leading to taxed
NOx emissions
(ton/yr)
Fuel consumption
leading to nontaxed NOx
emissions between
installations on the
Norwegian
continental shelf
(ton/yr)
Number of days
operating in areas
subject to NOx
tax**
For offshore service
vessels only
Year:
Year:
Year:
Estimated change in fuel consumption resulting from implementation of measure [%]
*Estimated fuel consumption and number of days in waters subject to NOx tax shall be given for
the first year with full operation for new buildings.
** If operation does not cover full days in areas subject to NOx tax, calculate days as number of
hours divided on 24 per day
Reduction of NOx emissions subject to NOx tax
NOx factor before NOx
reducing measure
(kg NOx / ton fuel):
NOx factor after NOx
reducing measure
(kg NOx / ton fuel):
NOx emission before
measure*** (kg/year)
What is the source of the NOx-factor:
☐ Customs standard factor.
☐ EIAPP certificate, with technical file
☐ Emission measurement carried out by accredited company
☐ Other (please specify).............................................
What is the source of the NOx-factor:
☐ Customs standard factor.
EIAPP certificate and technical file
Emission measurement carried out by accredited company
Other (please specify).............................................
NOx emission after
Estimated NOx reduction***
measure*** (kg/year)
(kg/year)
*** Documentation of how NOx-emissions are calculated shall de enclosed.
Application form 18.8.2015
3
Emission reduction between installations on the Norwegian continental shelf
NOx emission before
NOx emission after measure
Estimated NOx reduction
measure (kg/year)***
(kg/year)***
(kg/year)***
*** Documentation of how NOx-emissions are calculated shall de enclosed.
Consideration of why the measure is carried out
Is the measure trigged by external conditions or demands e.g. motor breakdown, demand
from the authorities, demand in tender or similar?
☐ No
☐ Yes, please specify:
Financial information
Additional cost for the measure
(NOK)****
Applied support (NOK)
**** Documentation showing specification of included costs shall be enclosed. Off-hire costs shall
not be included.
Bank account number for payment of support
Name of bank
Account number
IBAN number (if non-Norwegian bank)
SWIFT code (if non-Norwegian bank)
Signature
Name:
Date:
Enclosure
 Supplier offer and information about the measure
 Calculations and specifications of NOx-reduction and costs
 For LNG measure on ship, kindly enclose the form "LNG cost specification"
Application form 18.8.2015
4