REPÚBLICA DEMOCRÁTICA DE SÃO TOMÉ E PRÍNCIPE MINISTRY OF NATURAL RESOURCES, ENERGY AND ENVIRONMENT SÃO TOMÉ AND PRÍNCIPE 1 ST (EEZ) LICENSING ROUND APPENDIX A APPLICANT DETAILS AND FINANCIAL INFORMATION Completed Applications should be sent to: AGÊNCIA NACIONAL DO PETRÓLEO DE TOMÉ E PRÍNCIPE Av. das Nações Unidas, 225 Caixa Postal Nº 1048 São Tomé São Tomé e Príncipe SÃO
Version Issue Date Final 26/02/2010 APPENDIX A Applicant Details and Financial Information Page 2 of 10
APPLICATION FORM FOR PRODUCTION SHARING CONTRACT Petroleum Law 16/2009 & Petroleum Operation Regulations Part l Name(s) of Applicant(s) and Proposed Operator 1. Where there is more than one Applicant(s) please list the names according to the size of the proposed percentage interest, starting with the largest percentage: Name(s) of Applicant(s) (as in Certificate of Incorporation) Block Name Applying for. Proposed Percentage Interest(s) under the Licence(s) Applied for (These should total 100) 1 OPERATOR 2 3 4 1.1 State the name of the proposed operator company and whom to contact for correspondence regarding this application: a. Name of proposed operator company:. Name of contact: Address of contact: d. Tel / Fax number of contact: Post Code: e. E-mail Address of contact: APPENDIX A Applicant Details and Financial Information Page 3 of 10
1.2 Details of the Company Representative in São Tomé and Príncipe (if any or applicable) a. Name of proposed company Representative: (please attach CV) b. Address of contact: c. Tel / Fax number of contact: d. E-mail address of contact: Post Code: APPENDIX A Applicant Details and Financial Information Page 4 of 10
Part ll Application for Licence 1. Please list the BLOCK number(s) in order of preference: First Choice Second Choice Third Choice 2. State if any of the BLOCK(s) are linked (conditional or award of each other): APPENDIX A Applicant Details and Financial Information Page 5 of 10
Part lii Details of Operator and Applicant Note: The proposed operator should complete Section A. 1. a. Name of operator company (in full) / company number b. Place of incorporation: c. Principal place of business: d. Details of public listing on Stock Exchange All applicants should complete Section B each in the same order as in Part I. Section A - Details of Operator e. Address of registered Office: f. Tel / Fax number: Post Code: g. Place from which operations under the licence will be directed and controlled: * h. E-mail Address of contact: * If the place from which any commercial activities in connection with the licence sought will be directed and controlled differs from that in "c" above, this place should also be stated. 2. Members of the board of directors or other governing body of the Applicant: Name in Full Usual Residential Address Nationality APPENDIX A Applicant Details and Financial Information Page 6 of 10
3. Applicant s Skills and Experience in Petroleum Industry (include the parent company) as set out in Chapter II Articles 4 and 5 of the Petroleum Operation Regulations Environment Number of Licences Currently held Number of Operated Wells Drilled in last 5 years Exploration Appraisal Production Number of Producing Fields Average daily operated production (bopd/mmcsfd) Onshore Transitional Shallow Water Deep water Ultra Deep Water Total 4. Information on the Financial Standing (include parent company details) of Applicant: Class of Share Capital Amount Authorised Share Capital Amount Issued share Capital Voting Rights of Each Class of Shares APPENDIX A Applicant Details and Financial Information Page 7 of 10
1. a. Name of applicant company (in full): b. Place of incorporation: Section B - Details of other Applicants c. Principal place of business: d. Address of registered office: Post Code: e. Tel / Fax number: f. E-Mail Address of contact: g. Place from which operations under the licence will be directed and controlled: * * If the place from which any commercial activities in connection with the licence sought will be directed and controlled differs from that in "c" above, this place should also be stated. 2. Members of the board of directors or other governing body of the applicant: Name in Full Usual Residential Address Nationality APPENDIX A Applicant Details and Financial Information Page 8 of 10
3. Applicant s Skills and Experience in Petroleum Industry (include parent company details): Geological Environment Number of Licences Currently held No. Wells Drilled Exploration Appraisal Production Number of Producting Fields Average Net Daily Production BOPD/MMSCFD Onshore Transitional Shallow Water Deep water Ultra Deep Water Total 4. Information on the Financial Standing (include parent company details) of Applicant: Class of Share Capital Amount Authorised Share Capital Amount Issued Share Capital Voting Rights of Each Class of Shares APPENDIX A Applicant Details and Financial Information Page 9 of 10
Part IV Fees The fee for filling an application for the award of rights to conduct petroleum operations is: (See Annex B of Petroleum Operation Regulations) USD 25,000 Note: Application is not valid until payment has been received in National Petroleum Agency (ANP-STP). Part V Declaration You should ensure that the information given in Parts l, ll and lii of this form is approved by a duly authorised officer from each and every applicant company listed in Part l of this form, including the proposed operator company. I/We hereby declare that the information given in Parts l, ll and lii or annexed to or accompanying this application is true and accurate: 1. Signature Name (Block Letters) Capacity in which Signing Authorised to Sign on Behalf of 2. 3. 4. 5. 6. Date: Official company seal/stamp APPENDIX A Applicant Details and Financial Information Page 10 of 10