1 APPLICATION FOR THE RENEWAL OF A MINING PERMIT IN TERMS OF SECTION 27 OF THE MINERAL AND PETROLEUM RESOURCES DEVELOPMENT ACT, 2002, (ACT NO. 28 OF 2002) (The Act) 2 STANDARD DIRECTIVE All applicants applying for the renewal of a mining permit are herewith, in terms of the provisions of Section 29 (a) of the Mineral and Petroleum Resources Development Act, directed to specifically submit an application for such renewal to the relevant Regional Manager, which application must provide the specific information in the format required herein. The information requested herein is intended for small scale mining operators, and any permit holder may be required by the Regional Manager to provide further detailed information in addition to that required herein. The Regional Manager REGION 1. DETAILS OF THE APPLICATION. 1.1. Applicant details ITEM Name Tel no Fax no: Cellular no E-mail address Postal address 1.2. Permit details PERMIT REFERENCE NUMBER MINERALS STATED IN THE PERMIT RENEWAL PERIOD REQUIRED CONTACT DETAILS 3 2. ACTUAL MINING RESULTS AND FORECAST FOR THE RENEWAL PERIOD ITEM TOTAL DURING THE PERMIT PERIOD EXPECTED TOTAL DURING THE RENEWAL PERIOD TOTAL TOTAL R’000 R’000 PRODUCTION The mass or volume of the product to be produced in each quarter, either in tons, m 3, grams, carats, etc., whichever is applicable. ITEM PRICE The price received for the mineral sold REVENUE The mass or volume of production multiplied by the price OPERATING COST Operating cost of stores, materials, electricity, water, fuel and other TECHNICAL COMPETENCE COST TO BE PROVIDED FOR Cost of salaries, wages, labour, service providers, subcontractors, etc. ENVIRONMENTAL COST CAPITAL AND OTHER The cost of land, machinery, the plant, buildings and infrastructure. WORKING PROFIT / LOSS The revenue minus all the costs listed above 3. Map of the mine and rehabilitation (Provide a map of the mining area, showing the excavations, all stockpiles, dumps, dams, roads, buildings, plant areas together with their arial extent, and indicate therein the areas that are already rehabilitated, the areas not yet rehabilitated and the areas to be mined during the renewal period. The map may be attached as an appendix) 4 4. Actual Environmental during the permit period and estimated cost during the renewal period. ACTIVITY Mark with X which activities are applicable MITIGATION MEASURES Rehabilitation Excavating Dust control measures Noise control measures Blasting Stockpiles Storm water system Access control measures Rehabilitation Dust Control Measures Storm water system Rehabilitation Discard dumps or dams Loading, hauling and transport Dust control Measures Storm water system Noise control measures Dust control Measures Water supply dams and boreholes. Accommodation, offices, ablution, stores, workshops etc. Rehabilitation Rehabilitation Noise control measures Processing Plant Dust control Measures Storm water system Rehabilitation TOTAL STATE ACTUAL ENVIRONMENTAL COST DURING THE PERMIT PERIOD TO DATE. STATE THE ESTIMATED ENVIRONMENTAL COST FOR THE RENEWAL PERIOD 5 5. FINANCIAL PROVISION (Provide a calculation of the quantum, based on the map and dimensions provided in respect of rehabilitation still to be completed as shown on the plan in paragraph 3 above, which quantum must be calculated in accordance with the guideline contemplated in Regulation 54) 6. FINANCIAL AND TECHNICAL COMPETENCE (Provide the mine’s or the applicant’s latest bank statement to meet the financial and technical competence requirement) 7. MOTIVATION FOR THE RENEWAL PERIOD. (The applicant must provide short explanation (not more than one page) why the mineral deposit in the permit area was not mined out during the two year period of the initial permit, and provide an estimate as to how long it will take to mine the permit area completely at the current rate of production ). 8. IDENTIFICATION OF THE APPLICATION Herewith I, the person whose name and identity number is stated below, confirm that I am the Applicant or the person authorised to Act as representative of the Applicant in terms of the resolution submitted with the application, and confirm that the information provided above constitutes the official application for the renewal of the mining permit in terms of the provisions of Section 27 of the Act. Full Names and Surname Identity Number -END-