FORM PV- I

[see rules 160(2), and 168(3)]

Application for grant, amendment or renewal of a license to store or store and dispense liquefied
petroleum gas in liquefied petroleum gas dispensing station as automotive fuel to motor vehicles.
(RELEVANT DOCUMENTS LISTED OVERLEAF MUST BE ENCLOSED WITH THIS APPLICATION IF IT IS FOR THE GRANT OF A LICENCE IN FORM PV V
or PV-III)

(Replies to be written in the relevant box)

1. Name in which license is required to be granted. ( See notes below)

Name. National Identity Card No.
M/s. Sui Southern Gas Company N/A
2. Status (Tick the relevant box)

Individual
Company
Society
3. Applicants address

Postal address ST-4/B, Block 14, Sir Shah Suleman Road,

Gulshan-e-Iqbal, Karachi.

Permanent Address ST-4/B, Block 14, Sir Shah Suleman Road,

Gulshan-e-Iqbal, Karachi.
Telephones Nos. (+9221) 99021912
Telex / E. Mail asim.tirmizi@ssgc.com.pk

4. Qualification and experience of applicant and technical personnel employed by him. (Attach separate
sheet if required)

Name. Designation. Qualifications. Experience.

Aatir Salman ADGM(LPG) ME, BE 15 Year in SSGC
Farhan Umer Chief Engineer BE 12 Year of Oil & Gas Industry
Liaquat Ali Senior Engieer BE 19 Year in SSGC

5. Situation of premises

Province. District. Town or Survey No. Police Railway Station.

village. Station.

NA
Balochistan Awaran Awaran 1327 Awaran
6. Liquefied Petroleum Gas proposed to be stored:

Chemical name Details of LPG Vessels to be installed Total quantity

and composition of the
of Liquefied Nature. Nos. Capacity Manufacturer Liquefied
Petroleum Gas. of each name and origin. Petroleum
vessel. Gas.
Propane-70% Above-ground 02 60 MT M/S Hi-Tek Eng 120 MT
+Butan-30% Under-ground - - -
Mounded - - -

7. Have the premises already been licensed? If yes, please give details:
Sr. Form of License Quantity of HP/DP/CNG/LPG already stored.
No. license. No.

HP DP CNG LPG No of tanks/cylinders/

vessels
1 - - - - - - -
2

8. Additional information, if any

I hereby declare that the statements made above have been checked up by me and are true and I
undertake to abide by the terms and conditions of the license which will be granted to me.

Date: 5th July, 2017 Signature of applicant

Place: Karachi Head Office. (Authorized person in case of Company)
Full Name: Aatir Salman ADGM (LPG)

Address: ST-4/B, Block 14, Sir Shah Suleman Road, Gulshan-e-Iqbal, Karachi.
Notes: -
(1) In case where application in made in the name of a Company, the names and addresses of Directors and
Partners and the name, address and specimen signatures of person or persons authorized to sign
correspondence in respect of license applied for should be given on a separate sheet and enclosed with this
application form. Any change in the above information should be immediately communicated to the licensing
authority and authority renewing the license.
(2) Age to be given in case the applicant is an individual.
(3) DOCUMENTS REQUIRED TO BE SUBMITTED WITH APPLICATION FOR A LICENSE
(i) Four copies of specification and plans approved under rule 155 (not required for renewal a
license without amendment).
(ii) Specification with certificates of dispenser, piping, hoses and other fittings (required for grant or
amendment of license).
(iii) License together with approved plans and specifications attached thereto. (Not required for first
grant of license).
(iv) Fee for the grant, amendment or renewal of a license specified under the scheduled,
sub rule (2) of rule 169 and sub-rule (7) of rule 169, as the case may be, to be paid in the
manner specified in rule 11.
(v) A certificate of safety under rule 102 (not required for renewal of license).
(4) Delete whichever is not applicable.