APPLICATION FOR APPROVAL AS CARRIER Waste of hospital activities and health care class B2
PRODUCE DOCUMENTS

Aplication to sent by registered post or deposited against receipt letter

to the following address :

Direction de la Politique des Déchets

Département du Sol et des Déchets - DGARNE-SPW

avenue Prince de Liège 15

5100JAMBES

I)Legal entity that is or is not incorporated as a commercial business.

1°A copy of the deed of incorporation, articles of association and any amendments thereto.

2°The company's corporate purpose.

3°The capital of the company, the number of shares and the distribution of them between the different shareholders.

4°The list of names of all directors and persons with authority to bind the company.

5°The criminal records of persons listed in point 4 ° or failing any document replacing.

6°The exact address of the registered office and places of business;

The number of Bank Central Enterprise or VAT;

The telephone number, fax number, email address.

7°A note describing the nature and quantity of waste likely to be transported. Reference must be made to the codes and wording of the Order of the Walloon Government of 24 January 2002 amending the Order of the Walloon Government of 10 July 1997 establishing a waste catalogue.

8°A note on the human resources the company has or will have and including

-The composition and functions of staff;

-The list of drivers employed by the company;

-The copies of certificates ADR for drivers;

-The identity, the diploma and the experience of the person who will coordinate the waste transport activities.

9°A note on the safety advisors for the transport of hazardous goods, including:

-the full names and the addresses of the safety advisor(s);

-the place(s) where they perform their activities for the business;

-the nature of the legal bond with the business;

-a copy of the training certificates.

10°The list and features of the vehicles to be used to transport the waste;

A copy of the vehicle registration certificates;

A copy of the vehicle ADR compliance certificates.

Failing that, the applicant will present a vehicle acquisition plan.

11°A detailed inventory of the equipment, other than vehicles covered in point 10°, used in the transport activities.

12°A note on the financial capacity of the company:

-a certificate from the relevant Administration stating that the company fulfils their social security obligations;

-a certificate from the relevant Administration stating that the company fulfils their direct contribution obligations;

-a certificate from the relevant Administration stating that the company fulfils their VAT obligations;

-Copies of financial statements for the last three exercices- complete the form attached.

13°A copy of any authorisation the companymay hold in the Walloon Region, the Flemish Region, Brussels or abroad.

14°The formal commitment to take out the insurance policy indicated in Article 32 of the Order of the Walloon Regional Executive of 9 April 1992 on hazardous waste.

A form can be found in the appendix.

Company:
Year X / Year X-1 / Year X-2
Codes / Labels
in euros
Balance sheet extracted data
20/28 / Fixed assets / 0 / 0 / 0
20 / etablisment fees
21 / intangible assets
22/27 / tangble assets
28 / financial essets
29/58 / Current assets / 0 / 0 / 0
29 / receivables due after one year
3 / stocks and contracts in progress
40/41 / receivables to one year
40 / Ssort-term trade receivables.
50/53 / cash investments
54/58 / available values
490/1 / regularisation account
Total assets / 0 / 0 / 0
10/15 / Equity / 0 / 0 / 0
10 / capital
11 / emission premiums
12 / gains on revaluation
13 / réserves
140 / retained earnings
141 / deferred loss
15 / capital subsidies
16 / Provisions and deferred taxes
17 / Amounts payable after one year
42/48 / Amounts payable within one year
44 / short-term trade payables
492/3 / regularisation account
Total liabilities / 0 / 0 / 0
Income statement data retrieved
70 / turnover
600/8 / purchases goods
61 / miscellaneous goods and services
630 / operating depreciation
9901 / earnings (loss) operating
651 / financial depreciation
660 / extraordinary depreciation
9904 / profit for the year
9904 / loss for the year

II)Private individual

1°Full name of the applicant.

2°An extract of their criminal record or, failing that, of any document in lieu thereof.

3°The home address and the address of the place of business;

The Crossroads Bank for Enterprises or VAT number;

The telephone number, fax number and email address.

4°A note describing the nature and quantity of waste likely to be transported. Reference must be made to the codes and wording of the Order of the Walloon Government of 24 January 2002 amending the Order of the Walloon Government of 10 July 1997 establishing a waste catalogue.

5°A note on the human resources the applicant has or will have and including:

-the composition and functions of the staff;

-the list of the drivers employed by the applicant;

-a copy of the ADR certificates of the drivers;

-the identity, training and experience of the person who will coordinate the waste transport activities.

6°A note on the safety advisors for the transport of hazardous goods, including:

-the full names and the addresses of the safety advisor(s);

-the place(s) where they perform their activities for the business;

-the nature of the legal bond with the business;

-a copy of the training certificates.

7°The list and features of the vehicles to be used to transport the waste;

A copy of the vehicle registration certificates;

A copy of the vehicle ADR compliance certificates.

Failing that, the applicant will present a vehicle acquisition plan.

8°A detailed inventory of the equipment used for the transport activities, other than the vehicles described in point 7.

9°A note on the financial resources of the applicant:

-a certificate from the relevant Administration stating that the applicant fulfils their social security obligations;

-a certificate from the relevant Administration stating that the applicant fulfils their direct contribution obligations;

-a certificate from the relevant Administration stating that the applicant fulfils their VAT obligations;

-a copy of the tax certificates for the last three financial years.

10°A copy of any authorisation the applicant may hold in the Walloon Region, the Flemish Region, Brussels or abroad.

11°The formal commitment to take out the insurance policy indicated in Article 32 of the Order of the Walloon Regional Executive of 9 April 1992 on hazardous waste.

A form can be found in the appendix.

INSURANCE CONTRACT: STANDARD AGREEMENT FORM

I, the undersigned, ...... ,

undertake to take out an insurance contract covering the civil liability resulting from the operations linked to the transport of hazardous waste and to send a copy to the Département du Sol et des Déchets prior to the performance of the approved acts, on the understanding that the contract must stipulate:

- that no invalidity, plea or loss will be invoked against injured third parties;

- that its suspension or termination will take effect only following the expiry of six months from the date on which the Minister was apprised of the cause of the suspension or termination.

Done at ...... , on ......

Signature