F22334 APPLICATION REFERENCE NO…………… (FOR OFFICIAL USE) THE ENVIRONMENTAL

F22334 APPLICATION REFERENCE NO…………… (FOR OFFICIAL USE) THE ENVIRONMENTAL







F22334 APPLICATION REFERENCE NO…………… (FOR OFFICIAL USE) THE ENVIRONMENTAL


F22334 APPLICATION REFERENCE NO…………… (FOR OFFICIAL USE) THE ENVIRONMENTAL


F2/2334 Application reference No……………..

(For Official Use)


THE ENVIRONMENTAL MANAGEMENT AND CO-ORDINATION ACT (CAP 387) (GAZETTE NOTICE NO 2334)


APPLICATION FOR RENEWAL OF CLEARANCE FOR PRIMARY INDUSTRIAL PLASTIC PACKAGING

PART A: DETAILS OF THE APPLICANT

A1. Name (Individual or Firm)…………..………………………...…………………………………

A2. Business Registration No…………………………………………… (Attach Certificate of Incorporation and or Registration)

A3. KRA PIN Number………………………………………… (Attach copy of KRA PIN certificate)

A4. Physical Location of Business/Industry (Plot No. /LR. No.etc)…………………………………..

…………………………………………………………………………………………………………..

A5. County of Business/Industry…………………………………………………………………….

A6. Postal Address: …………..…………………………………………………………………….

A7. Name of contact person:…..………………………………………………….……………

A8. Position of contact person…………………………………………………………………..

A9. Address of contact person…………………………………………..…...……..………… Telephone No.……………………………………………………………………………………. Email:.…………………………………………………………….…………………………….

A10. Previous Clearance Reference Number……………………………………………………

PART B: CATEGORY OF CLEARANCE

F22334 APPLICATION REFERENCE NO…………… (FOR OFFICIAL USE) THE ENVIRONMENTAL

F22334 APPLICATION REFERENCE NO…………… (FOR OFFICIAL USE) THE ENVIRONMENTAL F22334 APPLICATION REFERENCE NO…………… (FOR OFFICIAL USE) THE ENVIRONMENTAL B1. Manufacturer Importer User




B2. Plastic packaging for which clearance is sought (tick as appropriate) and attach a Sample

a) Printed flat bags for industrial packaging

b) Printed courier bags

c) Printed hazardous/biomedical waste plastic liners d) Printed garbage bags

e) Other (specify) ………………………………………………………………………………..


B3. Product to be packaged in the plastic bag – as per B2(a) and B2(e) – (attach list where necessary)…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

B4. Certification by the Kenya Bureau of Standards (KEBS) if applicable (Attach evidence) ……………………………………………………………………………


B5. Source of the plastic bag (for non-manufacturers) …………….….……………………………


…………………………………………………………………………………………………………


……………………………………………………………………………………………………

B6. Quantity being applied for (in Kg/year) ………………..…………………………………………………………………………………….

B7. Quantity Manufactured/Imported/Used in the previous clearance period (in Kg/Year). Importers should attach copy of the Import Declaration Forms

…………………………………………………………………………………………………....

B8. Expected normal points of use of the plastic packaging


………………………………………………………………………………………………………


………………………………………………………………………………………………………



B9. Provide proof of adherence to previous clearance conditions as you indicate the Extended producer/user responsibility scheme or take back mechanism put in place to manage the waste plastic packaging during the previous clearance period (attach proof)


……………………………………….......................................................................................................


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PART C: DECLARATION BY APPLICANT




I hereby certify that the particulars given above are correct and true to the best of my knowledge and belief. I understand my clearance may be suspended, varied or cancelled if any information given above is false, misleading, wrong or incomplete.




Name……………………………………………………………………

Position ……………………………………………………………… Signature……………………………………… Date ……………………… Company/ Entity name and Seal/Stamp




PART D: OFFICIAL USE


Approved / Not approved/ Request for more information …………………………………………………………………………...………………………………


Comments………………………………………………………………………………………………

………………………………………………………………………………………………………..…

………………………………………………………………………………………………………..…

………………………………………………………………………………………………………..…


Name ………………………Position…………………………Signature………………Date………...



Important Note:

Please submit 1(one) copy of this completed Form and all the requisite documentary evidence to: Director General,

National Environment Management Authority

Popo Road, off Mombasa Road

P.O. BOX 67839-00200, Nairobi, Kenya

T el: (254 020) 2183718, (020) 2103696/ (020) 2307281

Mobile: 0724 253398, 0735 013046, 0723 363 010

E-mail: [email protected]; Website: www.nema.go.ke





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