REPUBLIC OF NAMIBIA
MINISTRY OF MINES AND ENERGY
APPLICATION FOR THE RENEWAL OF A
MINERAL DEPOSIT RETENTION
LICENCE
MINERALS (PROSPECTING & MINING) ACT, 1992, SECTION 84
(MINIMUM REQUIREMENT)
Date
Informal name of area
For Office Use
Reference
Deposit
Receipt no.
FlexiCadastre
sign
date
14/2/6/1/
N$
Date stamp
SECTION A – PARTICULARS OF APPLICANT
(i)
Natural person
Full names
Nationality *
Date of birth
Telephone
Facsimile
Residential address
Postal address
* Copy of Identification Document or Passport to be attached
(ii)
Company *
Full name
Registration number
Telephone
Registered address
Registration date
Facsimile
Principal place of business
Directors full names
Directors nationality
Share capital (N$)
% Share ** Full names
Nationality
Associated companies
Status
* Copy of Registration Certificate to be attached
** Holders of more than 5% of shares only
(iii) Accredited agent *
Full names
Telephone
Postal address

Facsimile
Physical address
All licence holders not resident in Namibia are required to (a) appoint an accredited
agent in writing who (b) must accept the appointment in writing and (c) must be
approved in writing by the Mining Commissioner. Copies of (a), (b) and (c) must be
attached. A consultant to a licence holder may not act as accredited agent.
2
SECTION B – APPLICATION PARTICULARS
Period applied for *
* Maximum 2 years
Size (Ha)
Mineral group(s) applied for
1
Base and rare metals
2
Dimension stone
3
Industrial minerals
4
Non-nuclear fuel
5
6
7
8
Nuclear fuel
Precious metals
Precious stones
Semi-precious stones
SECTION C – LOCALITY
(i)
Locality *
Map scale
1:
Magisterial district(s)
Region(s)
Regional division(s)
* Detailed locality plan to be attached
(ii)
No
List of farms covered by area applied for
Name
No
(iii) Co-ordinates of area applied for *
Label
Latitude
Longitude
Label
Name
Latitude
Longitude
*In degrees/minutes/seconds or decimal degrees, accurate to eight (8) decimal places.
GPS readings are not acceptable.
3
SECTION D – GEOLOGY OF AREA
Concise geological description *
* Any additional information acquired during the previous period of the licence must be
attached.
Mineral reserves *
Commodity
Mineral form
Grade
Tonnage
* Technical report, including appropriate plans, to be attache, if any addional
information has been acquired during the previous period of the licence.
Feasibility study *
Reasons why deposit is not currently exploitable
4
Estimate of earliest date when the deposit will be exploitable
Reasons why no further exploration is to be done
Detailed technical report to be attached (only if additional exploration activities took
place during the previous period of the licence).
SECTION E – ENVIRONMENTAL ASPECTS
(i)
Current condition of, and any existing damage to, the environment in the
area to which the application relates
(ii)
Estimate of effect which proposed exploration will have on environment
and proposed steps to be taken to prevent or minimise resulting damage
5
SECTION F – DETAILS OF OTHER MINERAL LICENCES
(i)
No
Other mineral licences, including claims, held in the preceding 10 years *
Type
Jointly with ?
Date issued
Expiry date
SECTION G - TECHNICAL & FINANCIAL RESOURCES
Personnel
Exploration manager *
Project leader *
Professional staff (number)
Support staff (number)
* CV to be attached
List of consultants (if applicable) *
Name
Organisation
Expertise
* Letters of Consent and CV’s to be attached
Financial resources available, if exploration activities are envisaged*
* Documentary proof to be attached
6
SECTION H - LIST OF ATTACHMENTS
No
1
2
3
4
5
6
7
8
9
10
11
Description
Copy of identification document/passport or company registration certificate
Accredited agent letter of appointment
Detailed locality map
Exclusive prospecting licence report (Section 76(1)(e)(i), where applicable)
Ore reserve technical report (where applicable)
Feasibility study (where applicable)
CV’s of geotechnical staff
Consultants letters of consent and CV’s
Proof of financial resources (where applicable)
Letter of consent from other existing license holders
Any other supporting documents
Compiled by :............................................................
Capacity
:............................................................
Signature
:...........................................................
7