Zambia Bureau of Standards P.O. Box 50259, Lechwe House, Freedom way-South end, Lusaka Tel: 260-21-1231385. Fax: 260-21-1238483 Email: zabs@zamnet.zm APPLICATION FOR A PERMIT TO SUPPLY (STANDARDS ACT, CAP 416 OF 1994) (COMPULSORY STANDARDS REGULATIONS) The information you provide on this document is collected by the Zambia Bureau of Standards under the authority of the Standards act for the purpose of issuing a permit. Type of application New Renewal Existing Reg. No (If applicable) Company Information Legal Status Private Limited Corporation Partnership Individual Cooperative Family Other Legal Name of Company Contact person Title Physical Address City /Town Postal Address Email Telephone Mobile Fax Product Information Which product are you applying a permit for? (Tick one box only) Fertilizer –Urea Bottled Water Refined Vegetable Oil Rubber Condom Biscuits Household Detergents Primary Dry Batteries Paints Used Textiles Number Plates Poultry Feeds Household Electrical Appliances Lead Acid Batteries Lubricants Jams Pig Feeds Fertilizer – Ammonium Sulphate Leather Safety Shoes Laundry Soaps Cement Cattle Feeds Calcium Ammonium Nitrate Peanut Butter Fruit Flavoured Drinks Wheat Flour Fertilizer -Ammonium Nitrate Plugs And Sockets Clear Beer Toilet Soap Compound Fertilizers Adapters Opaque Beer Electric Cables Maize Meal Imported Used Motor Vehicle Fuels Chalk Steel Yes Are any of your product brands certified to the applicable standard? No Product Brands 1.__________________________ 4.__________________________ 7.__________________________ 10._________________________ 2.__________________________ 5.__________________________ 8.__________________________ 11 _________________________ 3. _________________________ 6.__________________________ 9.__________________________ 12. ________________________ Production Annual production capacity __________________________________ Actual production in previous year Product turnover in previous year __________________________________ (ZMK) __________________________________ Declaration I have enclosed an application fee of K 275, 000 for the first brand of product and K15, 000 for each additional brand for a total of_______________________ (STATE AMOUNT) for the _________ (STATE NUMBER) brands applied for. I declare that I am authorized, on behalf of the company, to submit this application, and that the information contained herein is both correct and accurate to the best of my knowledge and belief. I hereby apply for a permit to supply the product brand(s) specified above. Name: ______________________________________________ Title: ________________________________________________ Signature: _______________________________________________ Date: ________________________________________________ Inspections Form IF 02 Rev. 05_2014 Page 1 of 2 INSTRUCTIONS Please complete all the applicable sections of this application form in BLOCK CAPITALS or in TYPE to apply for a permit. Each production facility requires a separate application form. Each product for which a different compulsory standard applies requires a separate application form. However, the application may contain all the brands of that product. Each application must be accompanied by the basic application fee for a product brand of K 275, 000 + VAT (K 319, 000) and K15, 000 + VAT (K17, 400) for each additional brand of that product. All information given to ZABS for the purposes of this application will be treated in the strictest confidence and according to the provisions of the Standards Act. The person making this application must hold EXECUTIVE AUTHORITY within the corporate structure that includes the facility for which the application is being made. A permit cannot be granted to a third party. This application form MUST BE SIGNED BY THE PERSON HOLDING EXECUTIVE AUTHORITY The stipulations of the GENERAL AND SPECIFIC PERMIT CONDITIONS for the PERMIT and the COMPULSORY STANDARD(S) appropriate to the product apply. INCOMPLETE APPLICATIONS will result in a delay in processing; therefore please ensure you have all the information required before returning this form to ZABS, and that you have read, understood and acted upon the appropriate standards. FALSE or MISLEADING INFORMATION will result in the rejection of the application. Once you have completed the application form IN FULL, SIGNED THE DECLARATION and enclosed or otherwise paid the application fee, a copy of this document may be faxed or emailed to ZABS, however a copy containing the original authorizing signature should also be mailed to ZABS. Please return to the following address: The Executive Director Zambia Bureau of Standards Lechwe House, Freedom Way - South End P.O. Box 50259 ZA 15101 Ridgeway Lusaka Tel: +260 01 238483/231385/227075 Fax: +260 01 238483 E-mail: zabs@zamnet.zm Inspections Form IF 02 Rev. 05_2014 Page 2 of 2