FORM 1C SURFACE RIGHTS BOARD PAGE 3 FOR DISPUTES

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Form 1C Surface Rights Board Page 3


For disputes about damages under the Petroleum and Natural Gas Act


I. PARTIES


This application is made by:

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:

Contact name:                                                                                                                       


Contact Name:                                                                                                                       

Company Name(if applicable):                                      


Company Name:                                           

Contact Address:                                           


Contact Address:                                           


City:
     

Province:
     

Postal Code:
     

City:
     

Province:
     

Postal Code:
     

Phone:
     

Fax:
     

Phone:
     

Fax:
     


Email:                                           

Email:                                           



II. PARTIES’ REPRESENTATIVES (Complete as applicable)


Agent for Applicant

Agent for Subsurface Rights holder

Contact name:                                                                                                                       

Contact name:                                                                                                                       

Company Name:                                           


Company Name:                                           

Contact Address:                                           


Contact Address:                                           


City:
     

Province:
     

Postal Code:
     

City:
     

Province:
     

Postal Code:
     

Phone:
     

Fax:
     

Phone:
     

Fax:
     

Email:                                           

Email:                                           



Counsel for Applicant

Counsel for Subsurface Rights holder

Contact name:                                                                                                                       

Contact name:                                                                                                                       

Firm Name:                                           


Firm Name:                                           

Contact Address:                                           


Contact Address:                                           


City:
     

Province:
     

Postal Code:
     

City:
     

Province:
     

Postal Code:

     

Phone:
     

Fax:
     

Phone:
     

Fax:

     

Email:                                           

Email:                                           



III. LAND


Legal Description of all parcels of land subject to the right of entry:

                                                                                                                      


PID:

                                          

Purpose of the right of entry (indicate as appropriate):

Wellsite

Pipeline

Other oil and gas installation (describe):

                                          

Mining operation (describe):

                                          

Other(describe):

                                          

If the Applicant is the owner or occupier of adjoining land, Legal Description of the adjoining land:
                                                                                                                      

PID:


                                          



IV. NATURE OF DISPUTE


Summarize the nature of the dispute and the specific issues where the parties disagree (attach additional pages if necessary):


                                                                                                                          



















V. SIGNATURE OF APPLICANT


To be signed by the Applicant: I hereby certify that all information given in this application is true and correct.


Signature:


Date:                                           


Name (printed):                                           


Company (if applicable):                                           




Include with this application:


When the Applicant is the Owner/Occupier of the land that has the right of entry:


  1. Title search of property subject to the right of entry (less than two weeks old).

  2. Affidavit(s) verifying service by registered mail on the parties to the application.

  3. If the application is filed by an Agent, a letter of authorization to act on behalf of the Applicant.

  4. 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:

  1. Title search of the adjoining property (less than two weeks old).

  2. Affidavit(s) verifying service by registered mail on the parties to the application.

  3. 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


Telephone:

Facsimile:

Toll-Free Telephone:

Toll-Free Facsimile:

604-775-1740

604-775-1742

1-888-775-1740

1-888-775-1742


E-Mail:

Website:

[email protected]

www.surfacerightsboard.bc.ca


Applications may be delivered to the Board directly or through any Service BC Centre (Government Agent)



See Information Sheet #2 - How to File an Application for more instructions.



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