Dated ----------------------

To

-------------------------

-------------------------

Ministry/Department

Application is herewith submitted for obtaining a mineral prospecting/mineral exploration permit in accordance

with the Myanmar Mines Law, furnishing the following particulars:

(A) To be filled up, if the application is made by an individual -

1. Name ---------------------------------------------------------------------------------

2. National registration certificate No./citizenship scrutiny card No. or passport No. ---------------------------------------------------------------------------------------------------------------------------------------------------

3. Residential address or address for communication -----------------------------------------------------------------------------------------------------(B) To be filled up, if the application is made by an organisation -

4. Name of organisation ------------------------------------------------------------(If a State-owned

organisation, to mention name of Ministry)

5. Registration No. of organisation/registration No. of society---------------------------------------------------------------------------------------------(photocopy of registration certificate of organisation/society to be attached)

6. Registered address of organisation -----------------------------------------------------------------------------------------------------------------------7. If capital is made up of shares, particulars of its share holders who own or have a beneficial

interest in more than 5% of the shares. ( to be attached)

8. Particulars regarding mineral prospection/mineral exploration block for which the permit is sought.

(a) location of area (village, township, district, state/division)---------------------------------------------------------------------------------------------

(b) area(in Swuare kilometres)---------------------------------------------------(to be accompanised by a 1 inch= 1 mile scale plan showing size of area or be accompanied by a scale map showing distinctly the area applied for, certified by the Land Records Department)

(c) type of mineral to be prospected/ explored.

(d) proposed period

(shall state a period not exceeding 1 year for mineral prospection, and a period not exceeding

3 years for mineral exploration)

9. Statement giving particulars of financial standing of the applicant to carry out the operation (to be attached)

10. Statement giving particulars of technical competence (expertise) or arrangements made for technical requirements (to be attached).

11.Proposed programme of mineral prospecting/mineral exploration operation and the estimated sum to be expended thereof.

(name and particulars of persons to be responsible for the programme, method to be employed,

particulars of equipment and estimated minimum amount of expenditure to be expended per square kilometre be mentioned).

12. Evidences of mineral occurrence in the proposed mineral exploration area.

13. Measures regrading prevention of possible detrimental effect to the environment and historical

monuments or to objects of cultural heritage, in carrying out mineral exploration operations in the

mineral exploration area. ( to be attached)

14.Ancillary requirements regarding mineral exploration operations and plans regarding such requirements. ( to be attached)

15. Matters which the applicant wishes the Ministry or the Department to consider (to be mentioned if any)-------------------------------------------------------------------------------------------------------------------------16. Details of any mineral permit held within the preceding four years in Myanmar or the equivalent of such a permit held by the applicant or the applicant together with any other person in another Country. ( to be stated and attached only for application involving foreign investment).

17. Particulars regarding appointment and training of Myanmar citizens. ( to be stated and attached only for application involving foreign investment).

18. Undertaking by the applicant.

I/We hereby certify that the information and particulars mentioned above and attached herewith

are true and correct and undertake to abide by the Laws Rules, Orders Dircetives and Conditions

contained in the permit.

Signature of applicant

Name ----------------------------------------------

N.R.C No or Passport No.-----------------------------------------------

(If an organisation the signatory shall be a person who has authority to sign on behalf of the organization)