Completing this application form

All applications for an explosives import certificate must be made using this application form.

If you are completing the application form electronically, use the mouse to move between fields, or press the
↑ or ↓ arrows on your keyboard. You may copy and paste from other documents.

You must complete the declaration and all sections of the application form. Failure to do so may cause your application to be delayed or declined.

Any supporting documentation must be clearly labelled and attached to the application form.

If you need help to complete the application form, phone the Inbound Customer Services Administrator
(0800 HAZ SUBS / 0800 429 7827 - overseas callers call +64 3 966 6226), or email

The application form may be completed manually or electronically; however the declaration must be signed manually. Print the application form to do this.

OFFICE USE ONLY
Application code / Date received
EPA contact / Application version number

6

Application for an Explosives Import Certificate

Official information

This application form has been approved under section 11(1)(fa) of the Hazardous Substances and New Organisms Act 1996 (HSNO). The Environmental Protection Authority (EPA) will use the information you provide in this form to consider your application for a certificate to uplift a tracked class 1 substance under regulation 4(2) of the Hazardous Substances (Tracking) Regulations 2001 and regulation 4(2) of the Hazardous Substances (Fireworks, Safety Ammunition, and Other Explosives Transfer) Regulations 2003.

Information you provide in this application form is subject to potential disclosure under the Official Information
Act 1982 (OIA). Commercially sensitive information must be marked as such and may be withheld in the event of an OIA request, if permitted by the OIA. Further information on the OIA is available at www.ombudsmen.parliament.nz

Privacy

You have the right to access and correct any personal information in connection with your application under the Privacy Act 1993.

Information provided as part of this application is collected by the EPA for the purpose of administering HSNO and the Hazardous Substances (Tracking) Regulations 2001.

Scope of application form

Regulation 4(2) of the Hazardous Substances (Tracking) Regulations 2001 requires that, before uplifting a tracked class 1 substance that has been imported into New Zealand, the importer must give to the New Zealand Customs Service a certificate, signed by or on behalf of the EPA, that the substance has an approval under section 29 of HSNO.

Regulation 4(2) of the Hazardous Substances (Fireworks, Safety Ammunition, and Other Explosives Transfer) Regulations 2003 specifies that the substances described in Schedules 1 to 3 of that Regulation are deemed to have been assessed and approved by the EPA under section 29 of HSNO.

Completing this application form therefore enables the EPA to determine whether:

·  a certificate is required for the uplift of the explosives you seek to import; and

·  the import of such explosives can be deemed to have been approved (and a certificate accordingly issued).

Definitions

These terms have the following meanings:

Term / Definition
Exporter / means a person by or for whom goods are exported, as further defined in the Customs and Excise Act 1996.
Importer / means a person by or for whom goods are imported, as further defined in the Customs and Excise Act 1996.
Tracked substance / means a hazardous substance that has 1 or more hazard classifications listed in Schedule 1 of the Hazardous Substances (Tracking) Regulations 2001 (not including those substances listed in paragraphs (a) to (g) of that schedule).
1.  Applicant details
1.1.  Applicant details in New Zealand
This is the information about the company importing the explosives.
Applicant’s legal name:
Company name – Importer
Applicant’s postal address:
Include postcode
Contact person:
Email address:
Phone:
/ (0_)
work / (0__)
mobile / (0_)
fax
1.2.  Freight forwarder (contact details)
This person should have sufficient knowledge to respond to queries and have the authority to make decisions that relate to the application on behalf of the applicant (or the ability to follow up with the appropriate authority).
Contact name:
Organisation and position:
Email address:
Phone:
/ (0_)
work / (0__)
mobile / (0_)
fax
1.3.  Certificate delivery
If the address is already noted above, please state whether it is to be couriered to the Applicant or the Freight forwarder.
Certificate delivery address:
Cannot be a PO Box
1.4.  Handling and storage information
Copies of the certificates are required for the first import to the location/handler if the quantity and class of explosives is over the threshold to require a location test certificate.
Physical address:
Proposed place of storage
Name of site:
Proposed place of storage
Location test certificate number:
Approved handler certificate number:
2.  Shipping information
Note: Please allow 10 working days for processing, from the receipt of payment and the completed application.
2.1.  Manufacturer and exporter's details
Exporter's legal name:
Company name
Exporter's address:
Include postcode
Manufacturer’s legal name:
Company name
Manufacturer’s address:
Include postcode
2.2.  Shipping information
Port of arrival:
State if using an airport
Consignment or reference number:
Please attach a bill of lading and an invoice or packing slip
Port or place at which the explosive was shipped:
Name of vessel or aircraft:
Including voyage number
Probable date of arrival:
If this is not known, please provide this information as soon as possible
3.  Explosives information
3.1.  Manufacturer and exporter's details
Declaration of explosives to be imported / Gross weight
of explosive
imported (kilos) / Number
of cases
UN number / Proper shipping name / Explosive description / part name, number / Hazard class
Total

(Attach a separate list if more space is required.)

4.  Declaration
This declaration must be completed by a person with the applicant’s signing authority.
·  I declare that to the best of my knowledge, the information contained in all sections of this application form, and supplied in support of this application, is complete and correct.
·  I declare that I have the authority to sign this application form and to provide this information.
·  I understand that information presented to the EPA is potentially subject to disclosure under the OIA 1982.
·  I understand that the EPA may require further information in relation to this application form.
·  I agree that the EPA may collect/verify information relevant to this application from/with other parties.
Name:
Position:
Signature:
Date:

September 2015 EPA0044