Form LS-2
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(Name of legal entity)
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(Place and date of application)
CROATIAN CHAMBER OF FORESTRY AND WOOD TECHNOLOGY ENGINEERS 10000 Zagreb, PrilazGjureDeželića 63
Pursuant to the provisions of Art. 5 Par. 1 of Law on Croatian Chamber of Forestry and Wood Processing Engineers (“National Gazette”, Nr. 22/06) and the Ordinance on issuing, renewal and revocation of the license for forestry, game management and wood processing operations, I hereby submit
APPLICATION
a) for issuing or
b) for renewal of the license for forestry operations
1. / Basic information on the legal entity1.0.Name ...... PIN: ......
1.1. Registration No: ...... 1.2. Date of registration ......
1.3.Address/headquarters: ......
1.4.Telephone/telefax: ...... 1.5. E-mail:......
1.6.Owner: ......
2. / Data for issuing/renewal of license2.0.Responsible person: ......
2.1. Authorized persons: ......
......
2.2. No. of employees: ......
2.3. No. of valid license: ...... 2.4. Duration of license ......
The application shall be submitted for the following types of forestry operations (pursuant to the Ordinance on types of forestry operations, minimum conditions for their implementation and works that could be undertaken by forest owners independently, NG No. 16/15) – the required fields to be marked by “+”:
No. / Type of operation / Preparationof work / Implementation of work / Supervision
of work
1.1. / Development of forest management plans
1.2. / Development of game management plans
1.3. / Development of programs for management of forest seed objects
2.1. / Silvicultural work
2.2. / Forest reproduction material – to be specified acc. to the Ordinance
3.1. / Protection – harmful organisms
3.2. / Protection – forest fires and natural disasters
4. / Timber harvesting
5. / Construction and maintenance of forest infrastructure
6. / Urban forestry
7.1. / Forest ecology
7.2. / Preservation of biodiversity
8. / Tree marking
9. / Management of private forest
Note*: ......
......
......
* to be specified if the supplement of a valid license for other type of stage of work is in question
Enclosed accompanying documentation (Art. 10 of Ordinance of licensing):
1. Evidence of legal personality, or registration
* Excerpt from the court, professional or trade register
2. Evidence of the required number of employees
*list of employees of the legal entity that will perform the operations that require the license, certified by the responsible person
3. Evidence of the required quantity of procured machines, equipment, measuring instruments and tools for performing a certain type or stage of work
*inventory list of basic instruments, status as of December 31st of the year preceding the submitting of the application or statement of the responsible person given under the financial and penal responsibility, certified by a public notary
4. Evidence of the professional qualifications of workers and of competence of responsible persons – certified engineers
*certificate for operators of machines and tools, certificate of IV degree, or Diploma for other degrees of education; decision on the enrollment into the Register of certified engineers - copies
5. Evidence of certificates and attests for the machinery, equipment, measuring instruments and tools required for a safe and reliable performance of a certain type or phase of work
6. Other documentation prescribed by special regulations
*for type of work: silvicultural operations, forest nursery operations, timber harvesting, construction and maintenance of forest infrastructure, urban forestry – evidence of workers’ qualifications for work safety;
*for type of work: protection of forests from harmful organisms – evidence of workers’ qualifications for handling hazardous substances.
7. A statement of the firm’s overall turnover in the preceding year
*extract from the profit and loss account or income tax form
8. Statement on the quantity of work performed in the preceding year
9. Statement of the responsible person on temporary/interim performance of activities in Republic of Croatia
I hereby certify under penalty of perjury, that the foregoing statements are true and correct:
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M.P. Signature of the applicant
By signing this application the applicant declares under penalty of perjury that the above information is true.
The applicant explicitly declares that he voluntarily ceded to disposal to the Croatian Chamber of Forestry and Wood Processing Engineers (further: Chamber) all the above stated information, and that he agrees that the Chamber keeps, stores, processes and uses them for purpose of identification, of keeping the Register of the licensed persons and other purposes in accordance with legal regulations.
The applicant agrees to notify the Chamber immediately if any changes to the above stated data occur.