JABATAN PERHUTANAN NEGERI SABAH

BORANG JPHTN(EIS) - C

BORANG PERMOHONAN LESEN PENGERINGAN TANOR (KILN DRY PLANT)

SILA PASTIKAN YANG KESEMUA DOKUMEN-DOKUMEN DAN PROSIDUR SEPERTI DI LAMPIRAN “A” ADALAH DISERTAKAN DAN DITURUTI.(Please ensure that all documents and procedures as listed in Appendix “A” are attached and adhered to)

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CHECK LIST FOR PEGAWAI PERHUTANAN DAERAH CONCERNED

No. Type Of Documents Please Tick ( / )

(1) Recommendation letter (assessment) from Pegawai Perhutanan Dearah.

(2) Borang JPHTN(EIS) – C

(2) A manufacturing licence if investment is RM 2.5 million or above, OR if full-time employee is more than 75 or more (Industrial co-ordination Act, 1975).

(4) Map of proposed site/area.

(5) Mill/Machinery layout plan.

(6) STIA/TAS/PPBS Membership certificate.

(7) Document which proof the legalilty of the company

a) Memorandum of Article of incorporationb) Form 49c) Form 24d) Trading Licencee) Company’s registration certificatef) Shareholders certificate

(8) Approval of mill/site project from

(i) The Municipal Council if site is within the town area/District office concerned.

(ii) Ministry of Environment(iii) Department of Industrial Development

(9) The usage of the proposed site does not contradict with any of the rules as stipulated in the land ordinance.

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(10) Generating plant licence.(Electrical Inspectorate Act, 1983)

(11) Diesel storage licence.(Ministry of Trade & Industry)

(12) Industrial Insurance (Required upon completion of the building and installation of Machineries).

(13) Certificate of fitness from “Jabatan Mesin dan Jentera”. (Before licence is issued by District Forest Officer.

(14) Manufacturers specification on the K/D Chamber.

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PROSIDUR PERMOHONAN LESEN KILANG KILN DRY(APPLICATION FOR A KILN DRY PLANT LICENCE PROCEDURE)

MEMOHON DENGAN KESEMUA DOKUMEN/BORANG YANG DIKEHENDAKI KEPADA PEGAWAI PERHUTANAN DAERAH

(APPLY WITH ALL DOCUMENTS AND FORMTO DISTRICT FOREST OFFICER)

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KOMEN PEGAWAI PERHUTANAN(DISTRICT FOREST OFFICER’S COMMENT)

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PEJABAT PENGARAH PERHUTANAN(DIRECTOR OF FORESTRY’S OFFICE)

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KETUA BAHAGIAN EKONOMI, INDUSTRI & STATISTIK(HEAD OF ECONOMY, INDUSTRY & STATISTIC DIVISION)

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KEPUTUSAN KEPADAPEGAWAI PERHUTANAN DAERAH DAN PEMOHON

(RESULT TO DISTRICT FOREST OFFICER AND APPLICANT)||

PENGELUARAN LESEN OLEHPEGAWAI PERHUTANAN DAERAH

(ISSUANCE OF LICENCE BY DISTRICT FOREST OFFICER)

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BAHAGIAN 1 (MAKLUMAT SYARIKAT)PART 1 (COMPANY’S PARTICULARS)

1. NAMA SYARIKAT : __________________________________________________(Name of Company)

2. ALAMAT : __________________________________________________(Address)

: __________________________________________________

: __________________________________________________

3. NO. TELEFON : __________________________________________________(Telephone No.)

4. NO. FAX : __________________________________________________(Fax No.)

5. NO. SIJIL PENDAFTARAN : __________________________ BERTARIKH : _____________(Registration Certificate No) (Date)

6. MODAL DIBENARKAN : ________________________________________________(Authorised Capital)

7. MODAL DIKELUARKAN : ________________________________________________(Paid-up Capital)

8. EKUITI SYARIKAT TEMPATAN : _________________________ %(Company’s Equity) (Local)

* ASING : _________________________ % (Foreign)

* SILA NYATAKAN KEWARGANEGARAAN* (Please specify nationality)

9. SYER BUMIPUTRA : ___________________________________________(Bumiputra Share)

10. NO. KEAHLIAN TAS : ___________________________________________(TAS Membership No.)

11. NO. KEAHLIAN STIA : ___________________________________________(SSIA Membership No.)

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12. SENARAI NAMA AHLI LEMBAGA SYARIKAT(Name of Company’s Board of Directors)

NAMA, NO.K.P ATAU NO. PASSPORT, ALAMAT & NO. TELEFON(Name, I.C No. or Passport No, Address, Telephone No.)

BILANGAN SAHAM(No. of Shares)

JAWATAN DALAM SYARIKAT(Position in the company)

PEKERJAAN(Occupation)

KEWARGA-NEGARAAN(Citizenship)

13. SENARAI PEMEGANG SAHAM SELAIN DARIPADA AHLI LEMBAGA PENGARAH SYARIKAT (List of Shareholders other than Company’s Board of Director)

NAMA, NO.K.P ATAU NO. PASSPORT, ALAMAT & NO. TELEFON(Name, I.C No. or Passport No, Address, Telephone No.)

BILANGAN SAHAM(No. of Shares)

JAWATAN DALAM SYARIKAT(Position in the company)

PEKERJAAN(Occupation)

KEWARGA-NEGARAAN(Citizenship)

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BAHAGIAN 11 : BUTIR-BUTIR KILANG(PART 11 : MILL’S PARTICULARS)

1. TEMPAT KEDUDUKAN KILANG : ____________________________________(Location of Mill)

2. KOS PROJEK : ____________________________________(Project Cost)

i) KOS TANAH RM ____________________________(Cost of Land)

ii) KOS BANGUNAN RM ____________________________(Cost of Factory Building)

iii) KOS MESIN RM ____________________________(Cost of Plant & Machineries)

iv) KOS LAIN-LAIN KELENGKAPAN RM ____________________________(Cost of Other Equipments)

JUMLAH KECIL RM ____________________________(Sub Total)

v) PERBELANJAAN PERSEDIAAN RM ____________________________(Preparational Expenditure)

vi) KAPITAL PERMULAAN RM ____________________________(Working Capital)

JUMLAH RM ____________________________(Total)

JUMLAH PELABURAN PROJEK RM ____________________________(Project’s Total Investment)

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1. JUMLAH `K/D CHAMBER’ YANG AKAN DIPASANG(Total number of K/D Chamber to be installed)

_________________________________________________________________________ Units

2. KAPASITI KESEMUA `K/D CHAMBER’ YANG DIDIRIKAN SEBULAN(Installed Capacity of K/D Plant per month)

___________________________________________________________________________ M3

JENIS OPERASI KILANG K/D(Type of operations of K/D Plant)

CONTOH : VACUUM DRYING/SOLAR HEATED/HEAT PUMP/DLL(Example : Radio Frequency-vacuum Drying/etc.)

_____________________________________________________________________________

3. JENIS KAYU UTAMA YANG AKAN DIKERINGKAN(Major Species to be Kiln-Dried)

Species MC %

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

4. PASARAN PENGELUARAN(Marketing of product produced)

EKSPORT : ________________________________________________ %(Export)

JUALAN TEMPATAN : ________________________________________________ %(Local Sales)

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5. PERMULAAN PEMBINAAN DAN PENGELUARAN(Commencement of construction and production)

BERMULA SELESAI(Start) (Completion)

a) KERJA MERATAKAN ________________ ______________(Leveling Work)

b) BANGUNAN KILANG ________________ ______________(Factory)

c) PEMASANGAN MESIN ________________ ______________(Machinery Installation)

d) PENGELUARAN ________________ ______________(Production)

6. SUMBER KAYU DIGERGAJI UNTUK DI K/D(Source of Sawn Timber to be K/D)

NAMA KILANG(Name of Mill)

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

7. PEKERJAAN(Employment)

JENIS BUMIPUTRA B/BUMIPUTRA RAKYAT PEKERJA(Type) (Bumiputra) (Non-Bumiputra) MALAYSIA ASING

(Malaysian) (Foreign Workers)___________________________________________________________________________________________________

a ESEKUTIF ______________ _______________ ______________ __________________(Executive)

b. PENGAWASAN TEKNIKAL ______________ _______________ _______________ __________________(Supervisory & Technical)

c. PERKERANIAN ______________ _______________ _______________ __________________(Clerical)

d. PEKERJA KILANG ______________ _______________ _______________ __________________(Factory Workers)

e. MAHIR ______________ _______________ _______________ __________________(Skilled)

f. TIDAK MAHIR ______________ _______________ _______________ __________________(Unskilled)___________________________________________________________________________________________________Total :___________________________________________________________________________________________________

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8. PENGELUAR/JENAMA K/D CHAMBER YANG AKAN DIPASANG(Manufacturer/Brand of K/D Chamber to be installed)

_______________________________________________________________________________

9. SPESIFIKASI SETIAP UNIT K/D CHAMBER(Specifications of each unit of the K/D Chamber)

_______________________________________________________________________________

_______________________________________________________________________________

10. ADAKAH K/D MENGGUNAKAN TENAGA LETRIK SEPENUHNYA ATAU MENGGUNAKAN `BOILER’ ?(Does the K/D Plan use boiler or entirely depend on electricity for heating).

______________________________________________________________________________

______________________________________________________________________________

SAYA MENGAKU BAHAWA SEGALA MAKLUMAT YANG DIBERI DI DALAM BORANG INI, DI SEPANJANG PENGETAHUAN DAN KEPERCAYAAN SAYA ADALAH BENAR DAN BETUL.(I hereby declare that to the best of my knowledge and belief, all information stated herein are true and correct).

TARIKH : _________________ ___________________________________TANDATANGAN PEMOHON DENGANCOP PERNIAGAAN(Signature of applicant with Company’s official stamp)

NAMA : ____________________________(Name)

KEDUDUKAN/JAWATAN :(Position/Designation)

___________________________________

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APPENDIX : A

APPLICATION FOR A K/D PLANT LICENCE REQUIREMENTS

(1) Recommendation letter (assessment) from Pegawai Perhutanan Daerah.

(2) Borang JPHTN(EIS) – C

(3) A manufacturing licence if investment is RM 2.5 million or above, OR if full-time employee is more than 75 or more (Industrial co-ordination Act, 1975).

(4) Map of proposed site/area.

(5) Mill/Machinery layout plan.

(6) STIA/TAS/PPBS Membership certificate.

(7) Document which proof the legalilty of the company

a) Memorandum of Article of incorporationb) Form 49c) Form 24d) Trading Licencee) Company’s registration certificatef) Shareholders certificate

(8) Approval of mill/site project from

(i) The Municipal Council if site is within the town area/District office concerned.(ii) Ministry of Environment(iii) Department of Industrial Development

(9) The usage of the proposed site does not contradict with any of the rules as stipulated in the land ordinance.

(10) Generating plant licence.(Electrical Inspectorate Act, 1983)

(11) Diesel storage licence.(Ministry of Trade & Industry)

(12)Industrial Insurance (Required upon completion of the building and installation of Machineries).

(13)Certificate of fitness from “Jabatan Mesin dan Jentera”. (Before licence is issued by District Forest Officer).

(14) Manufacturers specification on the K/D Chamber.

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