Explosives Act, 1875.
Application for a
Licence to Manufacture an Ammonium Nitrate Mixture
as specified in the Ammonium Nitrate Mixtures Exemption Order, 1997
S.I No. 365 of 1997
1. Applicant’s details
(Note: Where the application is made on behalf of a Company, the name and
address of the Company should be given):
Name:
……………………………………………....
Address:
……………………………………………….
……………………………………………….
……………………………………………….
……………………………………………….
2. Name and exact postal address of proposed site of manufacture (NB. see
footnotes below)
Name and Postal Address:
………………………………………………..
of proposed site of manufacture ………………………………………………..
………………………………………………..
………………………………………………..
………………………………………………..
National Grid Reference/s1
………………………………………………...
………………………………………………...
Geographical Survey of
Ireland Quarry No (if applicable)2 …………………………………………......
3. Proposed method of mixing
(Note: Give details of mixing equipment /pump type and operating company)
..............................................................................................................................
..............................................................................................................................
4. Period for which licence is applied for (where
known)…………………………….....................................................................
1
In all cases give the National Grid Reference. In the case of a quarry, give an appropriate grid
reference in the quarry within 500m of any proposed blasting site. In the case of a linear
construction site, such as a road development, where the proposed blasting area extends longer
than 1000m, multiple grid references at 500m intervals to cover each blasting site should be
included. In the case of a mine, give the National Grid Reference of the main portal.
Give Quarry No. if included in the ‘Geological Survey of Ireland Directory of Active Quarries,
Pits and Mines in Ireland’
2
5. Declaration
I declare that all of the information given in respect of this application is correct. I
undertake to ensure that any terms and conditions of a licence granted upon this
application will be observed. Furthermore, I undertake to send a copy of this
application for the information of the Inspector of Mines and Quarries in the
Health and Safety Authority (see note below).
Applicant signature:
………………………………………………..
Name: (Block Capitals):
………………………………………………..
Date:
…………………………………………………
Telephone No:
…………………………………………………
Fax No:
…………………………………………………
E-mail address:
…………………………………………………
Important – Additional notes to the completion of the above application form

Fee
The application fee in respect of a licence to manufacture an Ammonium Nitrate mixture is
€12.70. Cheques should be made payable to the Department of Justice, Equality and Law
Reform and sent, together with this completed application form, to:
Crime 4 Division
Department of Justice, Equality and Law Reform
94 St. Stephen’s Green
Dublin 2

Copies of application form to be forwarded to the Health and Safety
Authority
Copies of all application forms submitted to the Department of Justice, Equality and Law
Reform (DJELR) in respect of licences to manufacture Ammonium Nitrate Mixtures should
be sent, for information purposes, to the Health and Safety Authority. Applicants are
therefore requested to send such copies, at time of application to the DJELR, to the following
address:
Inspector of Mines and Quarries
The Health and Safety Authority
The Metropolitan Building
James Joyce Street
Dublin 4