THE ENERGY ACT, 2006 APPLICATION FORM FOR A PETROLEUM BUSINESS LICENCE (EXCEPT LPG)

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THE ENERGY ACT, 2006 APPLICATION FORM FOR A PETROLEUM BUSINESS LICENCE (EXCEPT LPG) (This application form is FREE and ERC does NOT charge any Licence fees) (A separate application form must be completed in respect of each separate business establishment) 1. Name of business/applicant 2. Details of applicant: a) Income Tax Personal Identification Number(s) b) Postal address c) Email Address : d) Location of business premises: Plot No Building Name Street/Market Town/District 3. Give full details of proprietors or partners owning business or directors/shareholders of the company, as the case may be. Name Nationality (Where applicable No. of shares held) 1

(Any additional information should be submitted on a separate sheet of paper.) 4. Give full details of directors of the company. Name Nationality Passport/ ID No. (any additional information should be submitted on a separate sheet of paper.) 5. Full description of the business (es) for which the licence is required 6. (a) Indicate the number and date of issue of any licence previously held under the Act. (b) Indicate the period for which the licence is being applied (maximum is one year from the date of issue). 7. State if you are or any of your partners/directors is an undischarged bankrupt. (If so indicate the names.) 8. (a) Has any previous application for a licence been rejected under the Act? (If so, give details) (b) Has any previous licence been cancelled under the Act? 9. (a) A criteria to be met for new application and for renewal of a licence is attached at the back of the application form. (b) Certified copies (by advocate / commissioner of oaths) of documents as per criteria specified above should be submitted together with the licence application. 2

10. CONDITIONS FOR IMPORTING AND MARKETING PETROLEUM PRODUCTS IN KENYA a) THE ENERGY ACT 2006 AND ANY OTHER SUBSIDIARY REGULATION b) REFINED PRODUCTS OFF TAKE AGREEMENT Companies importing petroleum products for the Kenyan market are required to purchase such quantities of refined petroleum products from the Kenya Petroleum Refineries Ltd (KPRL) as the minister may prescribe for such an importer having regard to market share and also undertake their imports through the Open Tender System (OTS). Refer to Legal Notice No.24, Kenya Gazette Supplement No. 26 of 10 th April 2012. c) MINIMUM OPERATIONAL STOCKS Companies importing petroleum products for marketing in Kenya are required to maintain minimum operational stocks as per Legal Notice Number 44 dated 10 th April 2008 d) SUBMISSION OF SALES DATA Companies marketing petroleum products in Kenya are required to submit monthly sales data. Refer to Legal Notice No. 31 of 18 th March, 2002 and any revision/amendment thereof DECLARATION i. I/We have read and understood the relevant sections of the Energy Act, No. 12 of 2006 and the related petroleum rules and regulations, and agree to abide with them. ii. iii. iv. I/We hereby certify that the information given above is to my/our knowledge true and accurate. I/We understand that it is an offence to give false information in an application for a licence. I/We understand that it is a serious offence to divert into the Kenyan market petroleum products destined for export. v. I/We understand that any person or company found diverting export petroleum products to the Kenyan market, either directly or indirectly will have the their licence cancelled. 3

vi. vii. I/We understand to conduct an honest petroleum business and shall ensure that my/our Company will not promote the diversion of export petroleum products into the Kenyan market either directly or indirectly. I hereby confirm that our Company/Business shall abide by the above terms and conditions with regard to importation and marketing of petroleum products in Kenya. I also understand that the trade licence issued for importation of petroleum for the Kenyan market is subject to these conditions. Name of Company: Name and ID of Person signing The Declaration: Designation and telephone No.: Signature & Stamp: Date: Email address: FOR OFFICIAL USE ONLY 1. Date application received: 2. Date of meeting of Petroleum Licencing Committee: 3. Decision of Petroleum Licencing Committee. Members present: Signature 1. 2. 4

3. 4. 4. If application is deferred or rejected, date of letter advising applicant accordingly 5. Date of review of application Decision of Committee Members present: Signature 1. 2. 3. 4. 6. License details No. Date issued Expiry date 5

THE ENERGY ACT, 2006 QUESTIONNAIRE TO BE FILLED BY NEW APPLICANTS FOR A PETROLEUM BUSINESS LICENCE 1. Name of applicant: 3. Nature of business (Sole Trader, Partnership, Private Company or Public Company): 4. Certificate of Incorporation/Registration Number and date: Country of Incorporation: Physical address: Postal address: Telephone/ fax: Email address: 5. Give particulars of proprietors or partners or directors/shareholders of Company as may be the case. Name Nationality Shares (if applicable) 6. Give details on equity capital including other sources of financing 7. Indicate bank references 6

8. Type of business required to be licensed (tick as appropriate): (i) (ii) (iii) (iv) (v) (vi) (vii) Refining. Importation. Exportation. Wholesale. Storage. Transportation. Specify any other 9. Indicate if you (a) (b) Own storage facilities (If so, give details including location and capacity) Have hospitality/rental arrangement (If so, give details including copies of any agreements) 10. Do you intend to market your product locally? If, (a) (b) Give the number and locations of Retails Outlets Give the number and locations of Distribution Depots including their capacities (c) If neither (a) nor (b) is applicable, explain (d) Give details on how you propose to maintain the approved quality of your product 11. (a) Give details of measures you have taken/you propose to take to ensure that the product you handle does not endanger life or pollute the environment 7

(b) Any additional information that the applicant wishes to give (If space provided above is not adequate use plain paper where applicable and attach to this questionnaire) Name of Company: Name and ID of Person signing The Declaration: Designation and telephone No.: Signature & Stamp: Date: 8

LICENCE EVALUATION CRITERIA FOR NEW PETROLEUM BUSINESSES (EXCEPT LPG) Criteria REF IMP EXP STO WH PL Application form Detailed Questionnaire Certified copy of Memo and Articles of association Certified copy of Certificate of Incorporation/Business registration Certified copy of PIN certificate Certified copy of VAT registration certificate Copy of a valid tax compliance certificate yes yes yes yes Certified copies of Identification documents for directors (ID/passport page 1 and 5) yes yes yes yes Work permits for non-citizens / Entry permit class H yes yes yes yes Certified copy of Lease agreement/tittle Deed Confirmation of application for membership to a National Oil Spill Group Confirmation from KPRL of a signed refined products off take Agreement Confirmation from MOE of signed OTS agreement for refined products Proof of ownership of at least 3 operational petrol stations in Kenya or a petroleum depot Environmental Impact Assessment Licence (if new) Copy of annual Environmental Audit acknowledgement letter from NEMA (Existing) Confirmation from KEBS that the facility complies with the Kenya Standard Certified copy of certificate of compliance with Physical Planning Act, 1996 Certified copy of clearance certificate from chief fire officer/fire Certificate Detailed approved drawing by local government drawn to scale Certified copy of certificate of registration of workplace by DOSHS 9

LICENCE EVALUATION CRITERIA FOR RENEWAL OF PETROLEUM BUSINESSES (EXCEPT LPG) Criteria REF IMP EXP STO WH PL Application form Copy of the previous petroleum licence Copy of a valid tax compliance certificate Letter from KPRL confirming compliance with the refined products off take agreement Proof of ownership of at least 3 operational petrol stations in Kenya or a petroleum depot Confirmation of active membership of a National Oil Spill Group At least 4 copies of purchases invoices as proof of previous licence utilization At least 4 copies of sales invoices as proof of previous licence utilization Copy of annual Environmental Audit acknowledgement letter from NEMA Certified copy of clearance certificate from chief fire officer/fire Certificate Certified copy of certificate of registration of workplace by DOSHS KEY REF Refining IMP Import EXP Export STO Storage WH - Wholesale PL Pipeline Transport 10