To

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Application is herewith submitted for obtaining " a subsistence mineral production permit" under the Myanmar Mines Law, furnishing the following particulars: -

1.    Applicant's

(a)  name .........................................................

(b)  national registration certificate No./ citizenship scrutiny card No.

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(c) address for communication ...........................

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2.     Proposed mining block's

( a )  location ........................................................

( b )  area.............................................................

3.     Proposed mining

( a )  mineral ...............................................................

( b )  method ................................................................

4. Plan regarding disposal and sale of mineral to be extracted ...........

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Signature of applicant.