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Health and Safety

Executive

Application for a Licence or Renewal of a Licence to Manufacture and/or compress and/or fill cylinders with acetylene gas at equal to or greater than 0.62 bar (g) under the Acetylene Safety (England and Wales and Scotland) Regulations 2014 (The 'regulations')

Please read the guidance notes (access via ?) before completing the application.

Application type and nature of business to be undertaken

*What activity is the application for? (Select all that apply)

*What is this licence application for?

(Select one)

*If this is a renewal/variation/transfer application, please state the date of expiry and any reference number

Details of the applicant

(if you applying on behalf of a company or limited liability partnership (or, in Scotland only, a partnership) please give it's name)

*Are you a company or an individual?

Where applicant is an individual

Note: for addresses you must provide Address Line 1 or 2, Town and postcode at minimum. If the applicant is a company or partnership, please give the registered address or where there is no registered address, the principal place of business

(eg building name)

(eg street)

(eg district)

Page 1 of 3

ASR1


Health and Safety

Executive

Application for a Licence or Renewal of a Licence to Manufacture and/or compress and/or fill cylinders with acetylene gas at equal to or greater than 0.62 bar (g) under the Acetylene Safety (England and Wales and Scotland) Regulations 2014 (The 'regulations')

Address where the activity will take place

Note: for addresses you must provide Address Line 1 or 2, Town and postcode at minimum

(eg building name)

(eg street)

(eg district)

If the applicant is not the owner/manager of the business, please give details of the person with management responsibilities for the relevant activity for which this licence is sought (eg Company Secretary, Director)

Name

*Is your address different from the activity address given above?

If yes, please provide the full address including postcode, of the person with the management responsibilities for the relevant activity

Note: for addresses you must provide Address Line 1 or 2, Town and postcode at minimum

(eg building name)

(eg street)

(eg district)

Out of hours contact details (if different from above) - please give the name, telephone number and/or mobile number if appropriate, of the person to be contacted in an emergency

Name

Page 2 of 3

ASR1


Health and Safety

Executive

Application for a Licence or Renewal of a Licence to Manufacture and/or compress and/or fill cylinders with acetylene gas at equal to or greater than 0.62 bar (g) under the Acetylene Safety (England and Wales and Scotland) Regulations 2014 (The 'regulations')

Declaration

Name

Please indicate the following documents are enclosed:

Page 3 of 3

ER1

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