Department of Economic Development

DEPARTMENT OF ENTERPRISE, TRADE AND INVESTMENT

Mineral Exploration and Development in Northern Ireland

Application for a Mineral Prospecting Licence

Before completing this form, please read the ‘Guidance for Applicants’ section in the report ‘Exploration and Development in Northern Ireland’.

Details of Applicant Company

Name / ______
Address
______Postcode ______
Telephone: ______Fax: ______
Date of incorporation of Company / ______
Place of incorporation / ______
(if this is outside N.Ireland, please provide full details on a separate sheet)
Type of business / ______
Principal place of business
(if different from above)
______Postcode ______
Registered office
(if different from above)
______Postcode ______
Place of central management control
(if different from above)
______
______Postcode ______

Details of Applicant Company (Cont’d)

Board of Directors

Name ………………………………………….
Address ………………………………………….
……………………………………………………….
……………………………………………………….
Nationality / Name ………………………………………….
Address ………………………………………….
……………………………………………………….
……………………………………………………….
Nationality
Name ………………………………………….
Address ………………………………………….
……………………………………………………….
……………………………………………………….
Nationality / Name ………………………………………….
Address ………………………………………….
……………………………………………………….
……………………………………………………….
Nationality
Name ………………………………………….
Address ………………………………………….
……………………………………………………….
……………………………………………………….
Nationality / Name ………………………………………….
Address ………………………………………….
……………………………………………………….
……………………………………………………….
Nationality

(continue on page 6 if necessary)

Class of capital ______

Amount issued £ ______

Amount authorised £ ______

Details of all holdings more than 10%, or value, of any class of capital which has been issued by the body corporate

Name(s) of holder ______

Class of holding ______

Amount £ ______

Nationality of holder ______

(continue on page 6 if necessary)

Previous experience in mineral prospecting and/or development work

Please detail ______

______

Details of area under application

Location/s______

______

Approximate size (sq km) ______

Minerals to be explored for______

______

If Minerals include precious

metals, have you already

applied to the Crown EstateYesNo(please tick)

Commissioners for a concurrent

licence?

Work programme

Geological rationale for making

application for the area______

______

(Continue on page 6 if necessary)

Work programme (Cont’d)

Proposed exploration

Programme for the area______

______

(Continue on page 6 if necessary)

Expenditure for proposed work programme

Estimated minimum amount

which the company intends to

spend carrying out:

Year 1 of programme £ ______

Year 2 of programme £ ______

Are sufficient funds available

now to fund the estimated costYesNo(please tick)

of the work programme?

If ‘Yes’ and the audited accounts

do not show the funds to be

available, please provide

details of the source______

______

(continue on page 6 if necessary)

If ‘No’ please provide details of

the intended source, and when

financial arrangements will be

completed______

______

(continue on page 6 if necessary)

Technical experts who will be involved in prospecting

Name ______Qualifications and experience ______

Additional information

Declaration

I declare that to the best of my knowledge the information given in this application is correct.

Signed ______Date ______

Name in capitals: ______E-mail: ______

Remember to enclose (please tick)Two original 1:50,000 outline maps showing the area under application

Cheque for £450 (made payable to: The Department of Enterprise, Trade and Investment)

Audited accounts for the last three years (and accounts from the parent Company if the application is from a subsidiary Company)

Please return your completed form to:Department of Enterprise, Trade and Investment

Minerals Branch

Room 102, Colby House

Stranmillis Court

BELFAST, Northern Ireland

BT9 5BF

P-0550/DI