To

.....................................

Ministry /Department

Application is herewith submitted for obtaining a large scale mineral/small scale mineral

production permit under 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 organization.

4. Name of organization .......................................

( If a State-owned organization to mention name of Ministry)

5. Registration No. of organization/registration No. of society

................................................................

(photocopy of registration certificate of organization/society to be attached)

6. Registered address of organization ...................

........................................................................

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 the mineral production block for which the permit is sought.

(a) location ( village, township, state/ division)

(b) area (in square kilometer)......................................................

.......................................................

(to be accompanied by a 1 inch =1 mile scale map showing the location and a: 5000

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)

9. Mineral to be extracted .....................................................

............. (sample to

be attached)

10. Development period...........................................

11. Production period..............................................

12. If application is for large scale mineral production -

(a) Programme for mining and processing operations consisting of the following:

(1) Estimated date for commencement of commercial production .

(2) Estimated volume of monthly or yearly production.

(3) Type and size of mineral products to be produced.

(4) Estimated recovery of minerals products.

(5) Estimate of capital investment.

(6) List of machinery equipment and services required for mineral production

operation .

(7) Cost of production.

(8) Marketing arrangement for mineral products.

(9) Income and cash flow statement.

(10) Details regarding possible method, period required and organization, for

acquiring planned capital.

13. If the applications for small scale mineral production, programme for efficient and beneficial

production of the minerals and marketing programme. ( to mention details regarding method

of mining, manpower/machines, volume of estimated products for one year, whether products

would be solely sold and distributed locally or to be exported).

14. Measures regarding rehabilitation and reclamation of land that may be detrimentally effected

to its previous state in various stages and the minimizing of the detrimental effects on surface

water and underground water due to large scale/small scale mineral production.(to be attached).

15. Measures regarding prevention of possible detrimental effects to the environment historical

monuments and antique objects of cultural heritage in carrying out large scale or small scale

mineral production operation.(to be attached).

16. Measures regarding prevention mitigation, control and elimination of health and other hazards

that could arise due to large scale mineral production/small scale mineral production.

17. Detail statement of anticipated ancillary requirements for large scale/small scale mineral

production and matters which the applicant wishes the Ministry or the Department to consider.

( to be attached).

18. Detail 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 )

19. Particulars regarding appointment, training and promotion of Myanmar citizens.

( to be stated and attached to application involving foreign investment.)

20. 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 Law, Rules, Orders, Directives

and Conditions contained in the Permit.

Signature ................................................

Name .....................................................

NRC No. or Passport No. ..........................

( If an organization, to be signed by person duly authorized to sign on behalf of the

organization)