WASTE COLLECTION PERMIT APPLICATION FORM

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1 Version 3.1 WASTE COLLECTION PERMIT APPLICATION FORM Guidance Notes & Application Form For Both New & Review Waste Collection Permit Applications Applicant Name: Telephone Number: Postal Address: FORM 1 IN ADDITION TO THIS FORM, PLEASE ENSURE TO COMPLETE AND INCLUDE: FORM 2: FORM 3: FORM 4: Waste Codes Table (Excel File) Supplementary Questions (applicable for specific waste types only, see Question 5.5 of this form) Household Kerbside Waste Service and Vehicles Table (Excel File) ALL FORMS ARE AVAILABLE TO DOWNLOAD FROM IMPORTANT Please note this application form is continuously updated. If this form has not recently been received or downloaded, you are advised to contact the National Waste Collection Permit Office to confirm that this is the most recent version. Please be aware that information supplied in this application, including supporting documentation, will be put on public display and open to inspection by any person. Following the application process your application may be made available under thefreedom of Information Act 2014

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3 Checklist of Information to be Supplied with Application INFORMATION REQUIRED: QUESTION INCLUDED One fully completed application form ONLY. All questions to be completed or marked not applicable. Confirmation of payment of application fee e.g.: receipt number/copy of EFT payment. An original Statutory Declaration form (Appendix 1). Signed by either sole trader, each partner or director where applicable. Completed Waste Codes Table (Excel file please download from One electronic copy to be submitted. Appendix 6 completed for each facility that is intended to be used in connection with the waste collection activity. All A copy of the Vehicle Registration Certificate for each vehicle. 5.8 A copy of current Tax Clearance Certificate from Irish Revenue. 6.4 An original Financial Declaration form (Appendix 3). 6.4 An original Motor Insurance Declaration form (Appendix 4). 6.5 An original Public Liability Insurance Declaration form (Appendix 5). For new applications: A copy of the relevant page from the newspaper(s) in which notice(s) have been published. (Template in Appendix 2). 6.5 Appendix 2 IF APPLICABLE PROVIDE THE FOLLOWING: QUESTION INCLUDED A copy of Notice from nominated authority instigating a review. 3.2 A copy of Certificate of Registration of Trade Name. 4.3 A copy of the printout from the Companies Registration Office detailing the Company Directors. A copy of the applicant s Certificate of Incorporation issued by the Companies Registration Office Supplementary Questions as may be required. 5.5 For Household Kerbside Waste Form 4 (excel spreadsheet of proposed household waste collection service and vehicles). For Household Kerbside Waste a Draft Customer Charter. FP2 form for the export of waste outside of the Island of Ireland (Port of export). A copy of the documentation specified by the NWCPO for the leasing of vehicles or the sub-contracting of waste collection. Supplementary Q.5 Supplementary Q i

4 IF APPLICABLE PROVIDE THE FOLLOWING: (Continued...) QUESTION INCLUDED Details of any court hearing, case, nature of the offence and any penalty or requirements imposed by the court. Where the applicant is a sole trader or partnership, include details of any such conviction where any relevant person or partner was at any time within the last 10 years prior to this application, a director, manager, company secretary or similar officer for a company. APPLICATION FEES New Application Fees: In the case of a single-region permit the fee payable is 1,000. In the case of a multi-region permit the fee payable is 1,000 per region, up to a maximum charge of 5,000 for all regions. Review Fees: In the case of a single-region permit the review fee payable is 500. In the case of a multi-region permit the review fee payable is 500 per region, up to a maximum charge of 2,500 for all regions. NEWSPAPER CHECKLIST APPLICATION TO OFFALY COUNTY COUNCIL AS NATIONAL WASTE COLLECTION PERMIT OFFICE (NWCPO), FOR A WASTE COLLECTION PERMIT RELATING TO A WASTE COLLECTION ACTIVITY OR WASTE COLLECTION ACTIVITIES IN (<<NAME REGION OR REGIONS>>) Full name and address of principal place of business of the applicant. State that the application for a Waste Collection Permit will be made to the NWCPO within 10 working days of the newspaper notice. Specify the nature of the waste collection activity to which the application relates (or use template as provided in Appendix 2) and the local authority area or areas where the collection activity or activities will be undertaken. State that a copy of the application will be available for inspection or purchase at the principal offices of the Local Authorities from as soon as is practicable after receipt by the NWCPO. Application Completed By: Signature BLOCK CAPITALS ii

5 Table of Contents Checklist of Information to be Supplied with Application i 1. GUIDANCE NOTES Introduction Who Do I Apply To? Fees Payable Pre-Application Research and Consultation Guidance on the Application Form and Process Additional Documentation to be Included About these Guidance Notes 3 2. APPLICATION GENERAL INFORMATION Application Type Consultant / Agent Details Pre-Application Consultation with the NWCPO 4 3. EXISTING PERMIT HOLDER DETAILS Existing Permit(s) Held by the Applicant Reason(s) for the Review of Existing Permits 5 4. ABOUT THE APPLICANT Applicant s Correct Legal Entity Full Name of Applicant(s) All Business Name(s) (Trade Names) Used, or Proposed to be Used Applicant(s) Contact Details The Local Authority Area where the Principal Office is Based Statutory Declaration Is the Applicant a Company? Is the Applicant a Partnership / Joint Applicant / Limited Liability Partnership? 8 5. ABOUT THE WASTE COLLECTION ACTIVITY Waste Collection Areas General Waste Activity Waste Type and Description Supplementary Questions for Specific Waste Types Waste Destination Facilities within the Island of Ireland (including Northern Ireland) Facilities Outside of Ireland TransFrontier Shipment (TFS) Waste Collection Vehicles 13

6 6. FIT & PROPER PERSON REQUIREMENTS Relevant Convictions Regional Waste Plan and/or National Hazardous Waste Management Plan requirements Technical Competence (Fit and Proper Person) Record Keeping and Reporting Financial Commitment Discharge Insurance Details Environmental Liability ADDITIONAL INFORMATION 19 Appendix 1 - Statutory Declaration 21 Appendix 2 - Suggested Newspaper Notice Format 23 Appendix 3 - Financial Commitment Discharge Declaration 25 Appendix 4 - Motor Vehicle Insurance Declaration 27 Appendix 5 - Public Liability Insurance Declaration 29 Appendix 6 Inclusion of an Authorised Waste Facility 31

7 Section 1 - Guidance Notes 1. GUIDANCE NOTES 1.1. Introduction On the 1 st of February 2012, Offaly County Council was designated as the Nominated Authority for the processing of all new Waste Collection Permit applications and Review applications. This single Nominated Authority is known as the National Waste Collection Permit Office (NWCPO). This form is for making an application for a Waste Collection Permit under the Waste Management (Collection Permit) Regulations S.I. No. 820 of 2007 as amended (hereafter referred to as the Regulations). This application form can be used to apply for a: New single region waste collection permit; or New multi region waste collection permit; or Review of a waste collection permit initiated by the NWCPO; or Review of a waste collection permit initiated by the permit holder. The application form and other relevant documents are available to download from the NWCPO web site In order to make the application process as efficient as possible, it may be necessary for the NWCPO to contact the applicant or a representative for the applicant while processing the application. The application contact person must have a good knowledge of the application form and the detail within. For this reason it is recommended that the application contact person should be the person who has completed the application form and any relevant supporting information. NOTE: An application for the review of a waste collection permit granted under the 2007 Regulations (as amended) must be made no later than 60 working days before the expiry date of the permit, if it is to remain in force Who Do I Apply To? All Waste Collection Permit applications and Waste Collection Permit Review applications made on or after the 1 st of February 2012 must be made to the National Waste Collection Permit Office. NATIONAL WASTE COLLECTION PERMIT OFFICE - CONTACT DETAILS Address NWCPO Offaly County Council Áras an Chontae Charleville Road Tullamore Co. Offaly Telephone Website 1

8 Section 1 - Guidance Notes 1.3. Fees Payable New Application Fees Review Fees Single-Region Permit 1, Multi-Region Permit Payment Method Credit Transfer or Direct Lodgement Postal Money Order or Bank Drafts Cash, Cheque, Credit or Debit Card 1,000 per region, up to a maximum charge of 5,000 for all regions. Instruction Lodge to Offaly County Council s Bank Account: Bank of Ireland, Bridge Street, Tullamore, Co. Offaly. Sort Code: Account Number: IBAN: IE64 BOFI IBIC: BOFIIE2D 500 per region up to a maximum charge of 2,500 for all regions. Please quote code and include applicant name. Crossed and made payable to Offaly County Council. Pay at the Cash Office in Offaly County Council, or pay with credit or debit card, over the phone. Phone Offaly County Council on Pre-Application Research and Consultation It is recommended that pre-application consultations or discussions with the NWCPO are undertaken before a formal submission of any of the above types of applications. These are primarily undertaken by telephone with one of the members of the NWCPO team. Prior to contacting the NWCPO for a pre-application consultation, the applicant is advised to identify the areas of the form which they require further guidance on. The applicant will get more benefit from the process if they prepare the form in advance. It is also recommended that the applicant familiarise themselves with the following, prior to completing the application: The Waste Management Act, 1996, Waste Regulations and Bye-Laws e.g. Waste Presentation Bye-Laws, Skip Bye-Laws. The List of Waste code book and the process for assigning waste codes. It is a requirement that the applicant familiarise themselves with the relevant Waste Management Plan/s for the region or regions and the National Hazardous Waste Management Plan if it is proposed to collect hazardous waste. Waste Management Plans are available to download from all local authority websites. The National Hazardous Waste Management Plan produced by the EPA, is available at Guidance on the Application Form and Process The contents of an application (new and review) and the information to accompany an application are specified in Articles 6 and 7 of the Regulations. This form has been designed in accordance with these articles. The application form is designed in such a way as to set out questions in a structured manner and not in the order presented in the Regulations. 2

9 Section 1 - Guidance Notes Certain sections in this application form may not be relevant to every application, or applicant. However, the applicant should look carefully through the complete form and provide all relevant information. If any question is considered 'not applicable this should be clearly stated. Additional attachments may be required to support the application. Attachments should be clearly numbered, titled and paginated and must contain the required information as set out in the application form. Where attachments are required they are detailed in the question. For the NWCPO to be satisfied that a valid application has been submitted or to make a decision on the application, further information may be requested from the applicant. This may delay the application process and is likely where insufficient information has been submitted. A decision in relation to an application for a waste collection permit will be made within: 40 working days from the date of receipt of a valid application, or 40 working days from the date of receipt of further information or particulars, or 25 working days from the date of receipt of any submission received Whichever period is the longest Additional Documentation to be Included Documents and information which must be supplied with the application are detailed throughout the application form and are summarised for convenience as a checklist on pages (i) and (ii) of this application form. Any applicant who does not submit all of the relevant documents will be contacted by the NWCPO to supply the missing documents within a set timescale. New applicants must advertise the proposed waste collection activity as outlined in Appendix 2. Please ensure that a copy of the page of the newspaper notice is attached to the application. The applicant is required to submit details in relation to the waste types and quantities that will be collected as per Question 5.4 of this application. The Waste Codes Table (FORM 2), (Excel spreadsheet) is available to download from This must be completed and submitted electronically. The applicant must complete the Supplementary Questions (FORM 3) for specific waste type s e.g. household kerbside waste, bulky waste, Waste Electronic and Electrical Equipment. These supplementary questions may not be applicable to all applicants. See Question About these Guidance Notes This application form and attachments do not purport to be, and should not be considered a legal interpretation of the provisions and requirements of the Waste Management (Collection Permit) Regulations, 2007 as amended. While every effort has been made to ensure the accuracy of the material contained in this application form, the NWCPO assumes no responsibility and gives no guarantees; undertakings or warranties concerning the accuracy, completeness or up-to-date nature of the information provided herein and does not accept any liability whatsoever arising from any errors or omissions. 3

10 Section 2 Application General Information 2. APPLICATION GENERAL INFORMATION 2.1. Application Type Please tick () the relevant box to which this application applies. (Only one box may be ticked). REVIEW OF A WASTE COLLECTION PERMIT OR PERMITS Complete all sections NEW WASTE COLLECTION PERMIT APPLICATION Complete all sections excluding Section Consultant / Agent Details Has the applicant a Consultant / Agent acting on their behalf? Yes No Please provide details of an appropriate contact or representative of the applicant. Contact Name Address Telephone Should all correspondence be sent to the agent s address? (where applicable) Yes No NOTE: If the answer is No, all correspondence will be sent to the applicant s address Pre-Application Consultation with the NWCPO Has the applicant had any form of consultation with the NWCPO in relation to the application? If Yes please provide the following details: Yes No Contact Name in NWCPO Date of Pre-Application Consultation 4

11 Section 3 Existing Permit Holder Details 3. EXISTING PERMIT HOLDER DETAILS 3.1. Existing Permit(s) Held by the Applicant If the applicant is the holder of existing waste collection permit(s), please complete the table below. Nominated Authority / Granted By Waste Collection Permit Number 3.2. Reason(s) for the Review of Existing Permits Where a permit holder is applying for a review of their Waste Collection Permit, explain the reason(s) for review (continue on separate sheet if necessary). If a review has been initiated by the NWCPO, please attach a copy of the notice initiating the review. Attached NOTE: When an application for a review has been submitted due to a significant change in nature, focus or extent of waste collection activity, the NWCPO may determine that a new application is warranted, e.g. commencing the collection of household kerbside waste or adding a new waste region(s) to the waste collection activity. Continue on separate sheets if necessary. Document(s) Reference: 5

12 Section 4 About The Applicant 4. ABOUT THE APPLICANT 4.1. Applicant s Correct Legal Entity Applicant(s) must be a legal entity. Please tick () the relevant type: (Only one box may be ticked). Sole Trader Partnership (including LLP) Limited Company (LTD) Designated Activity Company (DAC) Unlimited Company (UC) Company Limited by Guarantee (CLG) 4.2. Full Name of Applicant(s) Applicant(s) must be a legal entity (sole trader, partnership or company (body corporate)). In the case of joint applicants, identify the principal applicant. Name(s) Name(s) NOTE: The name provided above (4.2), is the name the permit will be issued under. The full name of the applicant must be consistent throughout the application form including newspaper notice (where applicable). If the applicant is applying as a company, it is important to include the suffix e.g. the word Limited or Ltd throughout the application form, including newspaper notice (where applicable). Inconsistent use of the applicant name / legal entity will result in the application being deemed invalid. 6

13 Section 4 About The Applicant 4.3. All Business Name(s) (Trade Names) Used, or Proposed to be Used Business Name (Trade Name) Business Name (Trade Name) Attach a copy of the Certificate of Registration of Business Name from the Companies Registration Office. ATTACHED 4.4. Applicant(s) Contact Details Please supply the address of the principal place of business, the telephone number, fax and address of the applicant. If the business is a partnership, please supply the name and address of the principal partner. Contact Name Address Telephone Fax * *A valid address must be provided with the application. NOTE: The above information (excluding contact name) will be provided on the Public Register at and the applicant s Waste Collection Permit The Local Authority Area where the Principal Office is Based Please state which Local Authority Area the principal place of business is based within. Local Authority Area (e.g. Dublin City Council) 4.6. Statutory Declaration A Statutory Declaration must accompany the application in the format provided in Appendix 1. To be signed by the applicant, each partner in the case of a partnership, each director in the case of a company. To be witnessed by a Solicitor/Commissioner of Oaths/Notary Public/Peace Commissioner/Garda Síochána. ATTACHED 7

14 Section 4 About The Applicant 4.7. Is the Applicant a Company? Attach a copy of the Certificate of Incorporation for the company. ATTACHED Attach a copy of the company printout from the Companies Registration Office detailing the company director(s) and other similar officers. ATTACHED NOTE: In the case of a company, please be advised that an original Statutory Declaration is required for each director (Appendix 1). Address of Registered Office of the Company: Address CRO Number 4.8. Is the Applicant a Partnership / Joint Applicant / Limited Liability Partnership? If the applicant is a partnership, please list the name(s) and address(es) of all other partners. Name & Address Name & Address Name & Address Name & Address Name & Address NOTE: In the case of a partnership, please be advised that an original Statutory Declaration is required for each partner (Appendix 1). 8

15 Section 5 About The Waste Collection Activity 5. ABOUT THE WASTE COLLECTION ACTIVITY 5.1. Waste Collection Areas Please tick () the relevant Local Authority Area(s) where the applicant proposes to collect waste. Regional groupings below are as per the Waste Management (Collection Permit) Regulations, 2007 as amended. MIDLANDS NORTH-EAST DUBLIN SOUTH-EAST LOCAL AUTHORITY All Local Authorities Laois County Council Tipperary County Council Longford County Council Offaly County Council Westmeath County Council Cavan County Council Louth County Council Meath County Council Monaghan County Council Dublin City Council Fingal County Council Dun Laoghaire-Rathdown South Dublin County Council Carlow County Council Kilkenny County Council Tipperary County Council Wexford County Council Waterford City and County Council CORK Cork City Council Cork County Council Clare County Council Limerick City and County Council Kerry County Council Galway City Council Galway County Council Leitrim County Council Mayo County Council Roscommon County Council Sligo County Council MID-WEST CONNAUGHT WICKLOW Wicklow County Council KILDARE Kildare County Council DONEGAL Donegal County Council 9

16 Section 5 About The Waste Collection Activity 5.2. General Waste Activity Please outline the proposed waste activity: Continue on separate sheets if necessary. NOTE: For new applications, please ensure that a copy of the page of the newspaper notice is attached to the application. See Appendix Waste Type and Description Please complete the Waste Codes Table to accompany this application (FORM 2 - Excel spreadsheet available to download at This table must be completed electronically and must be completed by all applicants. Applicants must provide details of the Collection Area (Local Authority Area), Waste Description, Type of Service and Destination Facilities by completing the Waste Codes Table. The applicant may need to refer to the List of Waste Code Book which can be downloaded from A separate Excel Spreadsheet (FORM 4) is required for applicants proposing to collect household kerbside waste (routine household bin collections). See Question 5.5 and Supplementary Question 6. For your assistance, sample rows have been completed in the Waste Codes Table. Please delete these rows before completion. ATTACHED 10

17 Section 5 About The Waste Collection Activity 5.4. Supplementary Questions for Specific Waste Types The following waste types have specific requirements in waste policy and/or legislation. Please identify if the proposed waste activity includes any or all by ticking the relevant boxes. The applicant is advised to refer to the List of Waste Code Book which may be downloaded from NB: If the applicant has selected any of these specific waste types or codes, the relevant Supplementary Question(s) in FORM 3 must be submitted. The Supplementary Questions (FORM 3) is available to download from Specific Waste Type Batteries and Accumulators List of Waste Codes *, *, *, , , *, *, Supp. Question Tick 1 Bulky Waste (Skip hire, household clear-outs) Commercial and Industrial (Non Production) Waste (door to door kerbside and packaging) Hazardous & Non Hazardous End of Life Vehicles (E.L.V. s) Hazardous Waste Codes from Chapter 15 (Packaging) and 20 (commercial kerbside) * and Any List of Waste code with an asterisk (*) 5 Household Kerbside Waste Code or from households 6 Sludges/Slurries and Septic Tank Waste , , , , , , , , , , , , , Waste Electrical and Electronic Equipment (WEEE) , *, , *, *, *, *, *, , *, , *, , *, Waste Tyres

18 Section 5 About The Waste Collection Activity NOTE: Should an existing permit holder decide to expand their business and include any of these waste types post grant (where they were not on the original permit), this will require a permit review. Where household waste was not previously included on a permit, this cannot be added through the review process, a new application is required Waste Destination Facilities within the Island of Ireland (including Northern Ireland) The NWCPO needs to be satisfied that for any and all waste types that the applicant proposes to collect, that authorised waste facilities are available for the deposition of the waste material. These authorised waste facilities will then be included as an appendix on any permit granted. Appendix 6 must be completed for each facility by both the applicant and the receiving facility. NOTE: Appendix 6 must be dated within 6 months of the application being submitted and be signed by a Facility Manager or equivalent appointed person(s). ATTACHED The use of sludge in agriculture is exempt from waste facility authorisation; however it must have a Nutrient Management Plan (NMP). Where the waste being collected is sludge for use in agriculture, and its destination is a landbank please provide evidence that an NMP is in existence for the proposed landbank(s) and that the plan(s) has / have been approved by the relevant Local Authority or the EPA. See also Supplementary Question Facilities Outside of Ireland TransFrontier Shipment (TFS) The transport of waste outside the Republic of Ireland (including to Northern Ireland) has additional regulatory requirements. It is advisable to contact the National Transfrontier Shipment Office (National TFS Office) at Dublin City Council ( /4601 or If the applicant proposes to use a waste facility outside the state, the following documentation is required for the Waste Collection Permit Application: For facilities in Northern Ireland a completed Appendix 6 is required. For the export of waste off the Island of Ireland, Ports of Export will be included on relevant permits rather than end destination facilities. To include a Port of Export on a waste collection permit please submit a completed FP2 Form for the Inclusion of a Port for Export with this application. NOTE: FP2 forms must be dated within 6 months of the application being submitted and be signed by a Broker or Originator (Producer) of the waste for export. The form is available to download at ATTACHED 12

19 Section 5 About The Waste Collection Activity Facilities outside of Ireland Continued: NOTE: The transport of waste by a haulier to the port for export is subject to the provisions of Regulation (EC) 1013/2006 on shipments of waste, and the Waste Management (Shipments of Waste) Regulations, Hauliers must be authorised to collect and transport the waste specified in a TFS notification or described in an Annex VII document to the port (contact the National Transfrontier Shipment Office (NTFSO) at Dublin City Council for further information). Waste shipments start from the time the waste consignment is transported by the haulier from the waste facility or site of origin to the port and must be accompanied by the TFS documents. The notifier shall provide to the NTFSO: o o Details of the carrier nominated in the notification, Evidence that the carrier is authorised to collect the specified waste types, & evidence that the carrier is authorised to transport the waste to the port of export indicated in the notification Waste Collection Vehicles Does the applicant currently have vehicles for waste collection? Yes No If yes, please provide the following details. (Continue on separate sheet if necessary). Vehicle Registration Number Vehicle Type Household Kerbside Waste Collection Vehicle Yes/No Owned/Leased or Owner Driver Copy of Vehicle Registration Certificate Included 13

20 Section 5 About The Waste Collection Activity Vehicle Registration Number Vehicle Type Household Kerbside Waste Collection Vehicle Yes/No Owned/Leased or Owner Driver Copy of Vehicle Registration Certificate Included Vehicle Registration Certificates must be attached for each vehicle and must be in the exact name of the applicant. In the case of sub-contractors / leased vehicles, further documentation is required (VR2/VR3 forms). These are available to download from Further details on vehicles used for the collection of household kerbside waste are requested in FORM 4 (excel spreadsheet of proposed household waste collection service and vehicles). NOTE: For applicants who do not have vehicles at the application stage, if granted a waste collection permit, they must provide vehicle details to the NWCPO prior to waste collection activities commencing. 14

21 Section 6 Fit & Proper Person Requirements 6. FIT & PROPER PERSON REQUIREMENTS 6.1. Relevant Convictions Has the applicant, including in the case of a company and/or any officer of that company, been convicted in the District Court of an offence, prescribed under Section 32(1) or Section 55(8) of the Waste Management Act 1996 or on indictment of an offence under Waste Management Act 1996, the Environmental Protection Agency Acts 1992 and 2003, the Local Government (Water Pollution) Acts 1977 to 2007 or the Air Pollution Act 1987 and 2011? Yes No If yes, please include a supplementary sheet detailing the court hearing, the case, nature of the offence and any penalty or requirements imposed by the court. Where there is more than one offence to be considered, please use a separate sheet for each offence. Where the applicant is a sole trader or partnership, include details of any such conviction where any relevant person or partner was at any time within the last 10 years prior to this application, a director, manager, company secretary or similar officer for a company. ATTACHED ATTACHED 6.2. Regional Waste Plan and/or National Hazardous Waste Management Plan requirements Please confirm that the applicant has familiarised themselves with the relevant Regional Waste Plans and Hazardous Waste Management Plan relative to the proposed activity. Yes 15

22 Section 6 Fit & Proper Person Requirements 6.3. Technical Competence (Fit and Proper Person) Please detail the applicant s technical knowledge and / or qualifications relevant to the collection of waste (continue on a separate sheet if necessary). Does the applicant have waste related qualifications? If Yes, please provide details below. Yes No Waste Related Qualifications: Does the applicant have relevant experience? If Yes, please provide details below. Yes No Relevant Experience: Other (complete if necessary): Document(s) Reference: 16

23 Section 6 Fit & Proper Person Requirements 6.4. Record Keeping and Reporting Please outline how the applicant as a permit holder proposes to: 1) Maintain records of waste collection activities 2) Prepare an Annual Return of the source, type, weight and destination of the waste collected. Where a third party will be maintaining records and/or completing the Annual Return on behalf of the applicant/permit holder, please outline this proposed arrangement Financial Commitment Discharge All applicants are required to make a signed declaration stating their financial ability to properly carry out waste handling and waste collection in a manner that will not cause environmental pollution or breach environmental standards. Please attach the following: Financial Declaration - Appendix 3 A copy of the applicant s current Tax Clearance Certificate issued by Irish Revenue ATTACHED ATTACHED NOTE: For applicants resident outside the Republic of Ireland, a Tax Clearance Certificate must be obtained from Irish Revenue. Failure to submit a current Tax Clearance Certificate will result in an invalid application. 17

24 Section 6 Fit & Proper Person Requirements 6.6. Insurance Details Please complete the insurance declaration documents contained in Appendix 4 and Appendix 5. These insurance declarations require that the applicant confirms that a sufficient insurance cover is in place for the proposed waste collection activity and include: A limit of indemnity of 6.5 million. An indemnity to Offaly County Council (as Nominated Authority on behalf of all Local Authorities in the Republic of Ireland). ATTACHED 6.7. Environmental Liability It is advised to investigate if Environmental Liabilities Insurance is appropriate for the proposed waste collection activity. While this is not a current requirement of the waste collection permit application process, it may be in the future. 18

25 Section 7 Additional Information 7. Additional Information If there is additional information which the applicant feels may be required or beneficial to the NWCPO in making its decision or any information identified during pre-application consultation, this should be included here. If there are any outstanding documents to be submitted that were not available when submitting the application, please outline here. Document(s) Reference: 19

26 APPENDICES

27 Appendix 1 Appendix 1 - Statutory Declaration ORIGINAL, STAMPED DOCUMENT TO BE SUBMITTED I declare that the information given in the application by 1 of 2 for the purpose of obtaining a waste collection permit is correct, and that no information which is required to be included in the said application has been omitted. I make this solemn declaration conscientiously believing the same to be true and by virtue of the Statutory Declarations Act I authorise OFFALY COUNTY COUNCIL as the NATIONAL WASTE COLLECTION PERMIT OFFICE to make any enquiries from official sources as it may consider necessary for the purpose of determining this application and, pursuant to Section 8 of the Data Protection Act 1988, I consent to the disclosure of details of convictions for relevant offences specified under Article 21 of the Waste Management (Collection Permit) Regulations Signature 3 : Name: (block capitals) Declared before me at 4 this day of, 20 Signature of Witness: Occupation: Date: WARNING: ANY PERSON WHO GIVES FALSE OR MISLEADING INFORMATION FOR THE PURPOSE OF OBTAINING A WASTE COLLECTION PERMIT RENDERS THEMSELVES LIABLE TO SEVERE PENALTIES. 1 Insert full name of the applicant (legal entity)i.e Sole Trader / Partnership / Company. 2 Insert address of the principal place of business. 3 To be signed by the applicant, each partner in the case of a partnership, each director in the case of a company. 4 To be witnessed by a Solicitor/Commissioner of Oaths/Notary Public/Peace Commissioner/Garda Síochána.

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29 Appendix 2 Appendix 2 - Suggested Newspaper Notice Format (Only in the case of a new application for a single or multi-regional waste collection permit) APPLICATION TO OFFALY COUNTY COUNCIL AS THE NATIONAL WASTE COLLECTION PERMIT OFFICE (NWCPO) FOR A WASTE COLLECTION PERMIT RELATING TO A WASTE COLLECTION ACTIVITY OR WASTE COLLECTION ACTIVITIES IN <<NAME OF RELEVANT REGION or REGIONS (see Note 1)>>. <<Applicant s full name (legal entity) & address of principal place of business>> will be making an application to the NWCPO, within ten working days from the date of this notice, for a waste collection permit to collect waste which may include hazardous & non-hazardous, commercial, industrial, household, construction & demolition waste, sludges, slurries & septic tank waste and other wastes in <<state name of local authority area or areas (see Note 2)>>. A copy of the application will, as soon as is practicable after receipt by the NWCPO be available for inspection and for purchase at the principal offices of the local authority area or areas listed above. NOTE : For new applicants: please ensure that a copy of the page of the newspaper notice is attached to the application and submitted within 10 working days of the notice appearing in the paper. For review applicants: where a newspaper notice is deemed to be required, a template will be provided by the NWCPO. An incorrect newspaper notice will result in an invalid application and the applicant having to re-advertise at additional cost and time.

30 Appendix 2 THE FOLLOWING NEWSPAPERS CIRCULATE IN ALL LOCAL AUTHORITY AREAS: The Irish Independent The Irish Times The Irish Sun The Irish Star The Irish Daily Mail Proof of circulation should be requested for all other newspapers Where some newspapers circulate in the majority of areas e.g. the Irish Examiner, or Evening Herald, then a combination of this paper plus a local paper will be acceptable. NOTE 1: The Regions are: North East, South-East, Cork, Mid-West, Connaught, Midlands, Wicklow, Kildare, Donegal, Dublin or All Regions. This can be worded for example as: The Midlands Region, or All Regions, or The Midlands, Cork and Dublin regions as appropriate NOTE 2: The Local Authority areas are: Meath, Cavan, Louth and Monaghan County Councils. Kilkenny, Carlow, Tipperary, Wexford, Waterford City and County Council. Cork County Council and Cork City Council. Limerick City and County Council, Clare and Kerry County Councils. Mayo, Leitrim, Roscommon, Sligo, Galway County Council and Galway City Council. Offaly, Laois, Longford, Tipperary and Westmeath County Councils. Wicklow County Council. Kildare County Council. Donegal County Council. Dublin City Council and Dun Laoghaire-Rathdown, Fingal and South Dublin County Councils. Or, for Multi-regional applications including all Local Authority Areas; All City and County Council Areas. All Local Authority areas where the applicant proposes to collect waste must be included in the newspaper notice to be deemed as a valid notice. Applicants are advised to seek advice in relation to their newspaper notice from the NWCPO. A newspaper notice will not be pre-approved and will only be validated by the office following the submission of a complete application. It is further advised to use the Newspaper Notice Checklist on Page ii.

31 Appendix 3 Appendix 3 - Financial Commitment Discharge Declaration ORIGINAL, STAMPED DOCUMENT TO BE SUBMITTED (To be completed by a financial representative of the applicant, e.g. Company Accountant or Bank Manager or Finance Director/Manager etc.) This document must be completed to satisfy the NWCPO that the applicant meets the full definition of a fit and proper person as defined in Article 4 of the Waste Management (Collection Permit) Regulations, 2007 as amended. Please note that under Article 17(3) the NWCPO shall not grant a waste collection permit unless it is satisfied that the applicant is a fit and proper person. All applicants are required to make a signed declaration stating their financial ability to properly carry out waste handling and waste collection in a manner that will not cause environmental pollution or breach environmental standards. FINANCIAL DECLARATION It is my opinion that the applicant (Name), based on his/her/the company s current financial circumstances, is in a position to meet current financial commitments and liabilities. Signature: OFFICIAL STAMP Name (Block Capitals): Position or Title: Financial Institution (if applicable): Date: WARNING: IT IS AN OFFENCE UNDER ARTICLE 36 (1) OF THE WASTE MANAGEMENT (COLLECTION PERMIT) REGULATIONS 2007, AS AMENDED, FOR ANY PERSON TO PROVIDE FALSE OR MISLEADING INFORMATION FOR THE PURPOSES OF OBTAINING A WASTE COLLECTION PERMIT.

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33 Appendix 4 Appendix 4 - Motor Vehicle Insurance Declaration ORIGINAL, STAMPED DOCUMENT TO BE SUBMITTED (To be completed by the applicant s insurance company/insurance broker) This document must be completed to satisfy the NWCPO that the applicant meets the full definition of a fit and proper person as interpreted in Article 4 of the Waste Management (Collection Permit) Regulations, 2007 as amended. Please note that under Article 17(3) (c) the National Waste Collection Permit Office shall not grant a waste collection permit unless it is satisfied that the applicant is a fit and proper person. MOTOR VEHICLE INSURANCE DECLARATION I confirm that the applicant (Name) has a Motor Vehicle Insurance Policy covering the use of all vehicle(s) registration(s) (if fleet policy state fleet policy ) in relation to their activities identified in Table 1 below, which are the subject matter of the Waste Collection Permit application including: A Third Party Property Damage Limit of 6.5m. Yes No An indemnity to Offaly County Council (as Nominated Authority on behalf of all Local Authorities in the Republic of Ireland), Yes No Policy No.: Expiry Date of Policy: Insurer: TABLE 1 Batteries and Accumulators Hazardous Waste Bulky Waste Household Kerbside Waste Commercial and Industrial (Non Production) Waste (door to door kerbside and packaging) Sludges/Slurries and Septic Tank Waste Construction and Demolition Waste Waste Electrical and Electronic Equipment Hazardous & Non-Hazardous End of Life Vehicles Waste Tyres

34 Appendix 4 MOTOR VEHICLE INSURANCE DECLARATION (Continued) Signature:... OFFICIAL STAMP Name (Block Capitals):... Position or Title:... Insurance Broker or Company:... Date:... ADDITIONAL COMMENTS: WARNING: IT IS AN OFFENCE UNDER ARTICLE 36 (1) OF THE WASTE MANAGEMENT (COLLECTION PERMIT) REGULATIONS 2007, AS AMENDED, FOR ANY PERSON TO PROVIDE FALSE OR MISLEADING INFORMATION FOR THE PURPOSES OF OBTAINING A WASTE COLLECTION PERMIT.

35 Appendix 5 Appendix 5 - Public Liability Insurance Declaration ORIGINAL, STAMPED DOCUMENT TO BE SUBMITTED (To be completed by the applicant s insurance company/insurance broker) This document must be completed to satisfy the NWCPO that the applicant meets the full definition of a fit and proper person as interpreted in Article 4 of the Waste Management (Collection Permit) Regulations, 2007 as amended. Please note that under Article 17(3) (c) the National Waste Collection Permit Office shall not grant a waste collection permit unless it is satisfied that the applicant is a fit and proper person. PUBLIC LIABILITY INSURANCE DECLARATION I confirm that the applicant (Name) has a Public Liability Insurance Policy covering their activities, identified in Table 1 below, which are the subject matter of the Waste Collection Permit application, including: Limit of indemnity of at least 6.5m any one occurrence, including sudden/unforeseen pollution risks. Yes No An indemnity to Offaly County Council (as Nominated Authority on behalf of all Local Authorities in the Republic of Ireland). Yes No Does Policy include Irish Law Jurisdiction? (only relevant if insured is based outside ROI) Yes No Policy No.: Expiry Date of Policy: Insurer: TABLE 1 Batteries and Accumulators Hazardous Waste Bulky Waste Household Kerbside Waste Commercial and Industrial (Non Production) Waste (door to door kerbside and packaging) Sludges/Slurries and Septic Tank Waste Construction and Demolition Waste Waste Electrical and Electronic Equipment Hazardous & Non-Hazardous End of Life Vehicles Waste Tyres

36 Appendix 5 PUBLIC LIABILITY INSURANCE DECLARATION (Continued) Signature:... OFFICIAL STAMP Name (Block Capitals):... Position or Title:... Insurance Broker or Company:... Date:... ADDITIONAL COMMENTS: WARNING: IT IS AN OFFENCE UNDER ARTICLE 36 (1) OF THE WASTE MANAGEMENT (COLLECTION PERMIT) REGULATIONS 2007, AS AMENDED, FOR ANY PERSON TO PROVIDE FALSE OR MISLEADING INFORMATION FOR THE PURPOSES OF OBTAINING A WASTE COLLECTION PERMIT.

37 Appendix 6 Appendix 6 Inclusion of an Authorised Waste Facility To be completed by the applicant and the authorised waste facility Name of Applicant: Address: APPLICANT DETAILS DETAILS OF THE AUTHORISED WASTE FACILITY TO BE ADDED (All of these details must be supplied) Facility Name: Facility Authorisation Reference Number: Facility Permit Expiry Date: LIST OF WASTE CODES THAT WILL BE DISPOSED / RECOVERED AT THE AUTHORISED WASTE FACILITY BY THE WASTE COLLECTION PERMIT HOLDER* (All of these details must be supplied) List of Waste Code Corresponding Waste Description Detailed Waste Description for Codes ending in 99 *please use additional sheet if necessary. AUTHORISED WASTE FACILITY PERMIT HOLDER DECLARATION I declare that the information I have provided to the Permit Holder is correct and that this facility is authorised to accept the waste types listed. Signed: Print Name: Position/Title: (where applicable) Date COMPLETED FORMS SHOULD BE POSTED TO: NWCPO, Offaly County Council, Áras an Chontae, Charleville Rd, Tullamore, Co. Offaly. Ph: Fax: Web:

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