Form
1C Surface Rights Board Page
For disputes about damages under the Petroleum and Natural Gas Act |
I. PARTIES
This application is made by: |
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Owner of land subject to a right of entry: |
Occupier of land subject to a right of entry: |
Owner/Occupier of land adjoining the property that has a right of entry: |
Applicant: |
Subsurface Rights holder: |
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Contact name:
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Contact Name: |
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Company Name(if applicable):
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Company Name: |
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Contact Address:
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Contact Address:
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City: |
Province: |
Postal
Code: |
City: |
Province: |
Postal
Code: |
Phone: |
Fax: |
Phone: |
Fax:
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Email: |
Email:
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II. PARTIES’ REPRESENTATIVES (Complete as applicable)
Agent for Applicant |
Agent for Subsurface Rights holder |
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Contact
name:
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Contact name: |
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Company Name:
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Company Name: |
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Contact Address:
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Contact Address:
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City: |
Province: |
Postal
Code: |
City: |
Province: |
Postal
Code: |
Phone: |
Fax: |
Phone: |
Fax: |
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Email: |
Email:
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Counsel for Applicant |
Counsel for Subsurface Rights holder |
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Contact
name:
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Contact name: |
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Firm Name:
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Firm Name: |
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Contact Address:
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Contact Address:
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City: |
Province: |
Postal
Code: |
City: |
Province: |
Postal Code:
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Phone: |
Fax: |
Phone: |
Fax:
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Email: |
Email:
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III. LAND
Legal Description of all parcels of land subject to the right of entry:
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PID:
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Purpose of the right of entry (indicate as appropriate): |
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Wellsite Pipeline Other oil and gas installation (describe):
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Mining operation (describe):
Other(describe):
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If
the Applicant is the owner or occupier of adjoining land, Legal
Description of the adjoining land: |
PID:
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IV. NATURE OF DISPUTE
Summarize the nature of the dispute and the specific issues where the parties disagree (attach additional pages if necessary):
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V. SIGNATURE OF APPLICANT
To be signed by the Applicant: I hereby certify that all information given in this application is true and correct. |
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Signature: |
Date:
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Name (printed):
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Company (if applicable): |
Include with this application:
When the Applicant is the Owner/Occupier of the land that has the right of entry:
Title
search of property subject to the right of entry (less than two
weeks old).
Affidavit(s)
verifying service by registered mail on the parties to the
application.
If
the application is filed by an Agent, a letter of authorization to
act on behalf of the Applicant.
Copy of the original surface lease, right of way agreement or Board right of entry order (with map of project, if available).
When the Applicant is the Owner/Occupier of the property adjoining the land that has the right of entry:
Title
search of the adjoining property (less than two weeks old).
Affidavit(s)
verifying service by registered mail on the parties to the
application.
If
the application is filed by an Agent, a letter of authorization to
act on behalf of the Applicant.
Forward the completed application and the above documents to the Board at:
Surface Rights Board 1270 – 605 Robson Street Vancouver, BC V6B 5J3
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Telephone: Facsimile: Toll-Free Telephone: Toll-Free Facsimile: |
604-775-1740 604-775-1742 1-888-775-1740 1-888-775-1742
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E-Mail: Website: |
www.surfacerightsboard.bc.ca |
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Applications may be delivered to the Board directly or through any Service BC Centre (Government Agent)
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See Information Sheet #2 - How to File an Application for more instructions.
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