LICENSING APPLICATION FOR IMPORT/EXPORT AND TRANSIT OF ENERGY I APPLICATION SUBMITTED FOR: (please tick applicable option) LICENSE FOR IMPORT/EXPORT AND TRANSIT OF ENERGY RENEWAL OF LICENCE FOR IMPORT/EXPORT AND TRANSIT OF ENERGY TRANSFER OF LICENCE FOR IMPORT/EXPORT AND TRANSIT OF ENERGY APPLICATION FROM MW TO MW (indicate MW requested under the license. See Rules on Fees, Annex 1) II APPLICATION INSTRUCTION Applicants shall fill in this application form and attach all proof/documents required under this application. The applicant shall submit the completed application in both hard copy and electronic version. Hard copies to: Energy Regulatory Office, Rr. Dervish Rozhaja nr. 12, 10 000 Prishtinë, Republika e Kosovës Electronically to: ero.legal-licensing@ero-ks.org Certification of enclosed documents All information and declarations provided hereunder shall either be originals or certified (notarized) as accurate and genuine, and shall contain the applicant s signature and stamp. If applications need more space to describe an issue or an item of this application, they may use blank sheets, which shall be attached to this application. APPLICANT S NAME (LEGAL PERSON): APPLICANT S STAMP: Adresa: Rr. Dervish Rozhaja nr. 12, 10000 Prishtinë, Kosovë Tel: 038 247 615 lok.. 101, Fax: 038 247 620, E-mail: info@ero-ks.org, web: www.ero-ks.org 1
III APPLICANT S GENERAL INFORMATION APPLICANT S NAME (LEGAL PERSON): PRINCIPAL PLACE OF BUSINESS: ADDRESS: REGISTRATION NO: EMAIL ADDRESS: NAME AND SURNAME OF CONTACT PERSON ADDRESS: FAX NO: EMAIL ADDRESS: CURRENT APPLICANT ACTIVITIES IN THE AREA OF ENERGY IN KOSOVO: 1. PREVIOUS APPLICANT ACTIVITIES IN THE AREA OF ENERGY IN KOSOVO: 1. 2
IV EVIDENCE NEEDED TO BE SUBMITTED Instruction: Please tick (to the right) all documents attached to the application form: NO. PROOF/DOCUMENT (ORIGINAL OR CERTIFIED) ATTACHED (PLEASE TICK) 1. Applicant s business registration certificate, issued by the authorized business registration agency. 2. Applicant s Business Plan for the next three (3) years. 3. Applicant s financial statement for the last three (3) years. These financial statements shall be audited by licensed and independent financial auditors. The application shall submit the audit report separately from the financial statement, while newly-established companies should submit the financial statement and information with respect to experience of their partners or shareholders, if any, in conducting similar energy related activities. 4. Certificate issued by a financial institution or other institutions confirming availability of sufficient funds for exercise of energy related activities (e.g. bank guarantees issued to the applicant or the parent company in case of subsidies, or similar evidence of sufficient funds available to fund the activity to be covered by the license). 5. Certified copy of shares registration or real shares of every shareholder or applicant s partners (e.g. company s founding charter, court decision, certified copy of shareholders, company s statute, etc.). 6. Certificate from competent authority that applicant has met all legal obligations related to payment of taxes in the country of registration as legal entity. 7. Certificate from competent authority that applicant is not a subject of liquidation/bankruptcy proceedings, that its business is not placed under court administration and that its business operations have not been suspended. 8. Details of applicant s experience in performing energy related activities in the form of a company biography (Curriculum Vitae CV). 3
9. Information about the applicant s organization structure (management and professional personnel). 10. Biographies (CVs) of managerial staff and other senior personnel, along with their qualifications. 11. Proof of payment of applicable licensing fee (in line with Article 6, paragraph 5 of the Licensing Regulation). 12. A description for planed energy activities. 13. Proof over any kind of license that applicant is in possession in relation with the energy activities, in Kosovo or in any other place. V APPLICANT S DECLARATION Instruction: Please answer with YES or NO to the following statements. NO STATEMENTS YES NO 1. Have any of the applicant s managers been sentenced or prosecuted for criminal acts? 2. Has the license for the activity applied for been revoked in the past five (5) years since the date of application submission? 3. Are there all necessary approvals related to environment protection or other approvals specified in the applicable laws? 4. Does the applicant understand and is he/she aware of his/her obligations to comply with the energy sector legislation, regulations issued by ERO, commercial and technical codes and other legislation in effect? 4
Statement I (responsible person)... (name and surname) hereby declare that all information, evidence and documents attached to this application are, to my knowledge, original and accurate and that I am subject to sanctions for false evidence and providing false information. POSITION OF RESPONSIBLE PERSON: DATE: PLACE: SIGNATURE: STAMP: 5