Request for permission to import chemicals used in the production of explosives - Form 1
<h3 style="text-align: center;">Request for permission to import chemicals used in the production of explosives - Form 1</h3> <div style="text-align: left; zoom: 76%;"> <p style="text-align: center;"> Materials belonging to the first list </p> <table dir="ltr"> <tr> <td colspan="4" style="text-align: center; background-color: #dfdfdf;">Importer Information</td> </tr> <tr> <td> Facility name: </td> <td colspan="3" style="width: 90%"></td> </tr> <tr> <td>Commercial registration number: </td> <td colspan="1" style="width: 40%"></td> <td>Registration date: </td> <td colspan="1" style="width: 40%"></td> </tr> <tr> <td>City:</td> <td colspan="1" style="width: 40%"></td> <td>Email:</td> <td colspan="1" style="width: 40%"></td> </tr> <tr> <td>Address:</td> <td colspan="1" style="width: 40%"></td> <td>P.O. Box: </td> <td colspan="1" style="width: 40%"></td> </tr> <tr> <td>Mobile:</td> <td colspan="1" style="width: 40%"></td> <td>Telephone:</td> <td colspan="1" style="width: 40%"></td> </tr> </table> <table dir="ltr"> <tr> <td colspan="12" style="text-align: center; background-color: #dfdfdf;"> Chemical data</td> </tr> <tr> <td style="width: 5%; text-align: center;" rowspan="2">M</td> <td style="text-align: center; width: 15%;" colspan="2">Scientific name: </td> <td rowspan="2" style="width: 10%; text-align: center;">Trade name:</td> <td style="text-align: center; width: 10%;">Customs item: </td> <td style="text-align: center; width: 10%;">Chemical abstract:</td> <td style="text-align: center; width: 20%;" rowspan="2">required quantity annually</td> </tr> <tr> <!-- <td></td> --> <td style="text-align: center;">Arabic</td> <td style="text-align: center;">English</td> <td style="text-align: center;">(HS)</td> <td style="text-align: center;">(CAS)</td> </tr> <tr> <td style="width: 5%; text-align: center;" rowspan="4">1</td> <td style="text-align: center; width: 10%;" ></td> <td style="text-align: center; width: 10%;"></td> <td rowspan="4" style="width: 10%; text-align: center;"></td> <td style="text-align: center; width: 10%;" rowspan="4"></td> <td style="text-align: center; width: 10%;"></td> <td rowspan="4" style="text-align: center; width: 10%;" style="text-align: center;"></td> </tr> <tr> <td></td> <td></td> <td></td> </tr> <tr> <td></td> <td></td> <td></td> </tr> <tr> <td></td> <td></td> <td></td> </tr> <tr style="border-top: 1px solid #353535;"> <td style="border-top: 2px solid #353535; width: 5%; text-align: center;" rowspan="4">1</td> <td style="border-top: 2px solid #353535; text-align: center; width: 10%;" ></td> <td style="border-top: 2px solid #353535; text-align: center; width: 10%;"></td> <td style="border-top: 2px solid #353535; width: 10%; text-align: center;" rowspan="4"></td> <td style="border-top: 2px solid #353535; text-align: center; width: 10%;" rowspan="4"></td> <td style="border-top: 2px solid #353535; text-align: center; width: 10%;"></td> <td style="border-top: 2px solid #353535; text-align: center; width: 10%;" rowspan="4" ></td> </tr> <tr> <td></td> <td></td> <td></td> </tr> <tr> <td></td> <td></td> <td></td> </tr> <tr> <td></td> <td></td> <td></td> </tr> </table> <table> <tr> <td colspan="4" style="text-align: center; background-color: #dfdfdf;">Applicant Information </td> </tr> <tr> <td style="width: 25%; text-align: center;">Name of the Director of the Importing Authority or the Authorized Person in full: </td> <td style="width: 30%; text-align: center;"></td> <td style="text-align: center;">Stamp</td> </tr> <tr> <td style="width: 25%; text-align: center;">ID Number:</td> <td style="width: 30%; text-align: center;"></td> <td rowspan="4"></td> </tr> <tr> <td style="width: 25%; text-align: center;">Mobile:</td> <td style="width: 30%; text-align: center;"></td> </tr> <tr> <td style="width: 25%; text-align: center;">Email: </td> <td style="width: 30%; text-align: center;"></td> </tr> <tr> <td style="width: 25%; text-align: center;">Authorized signature and date </td> <td style="width: 30%; text-align: center;"></td> </tr> </table> <div dir="ltr"> <p dir="ltr" style="text-align: left;"> <h4>Name of the relevant authority:</h4> </p> <div style="display: flex; justify-content: space-between;"> <div style="display: flex; align-items: center; margin-bottom: 10px; justify-content: end; gap: 15px;"> <div style="display: flex; align-items: center; gap: 10px;"> <span>Disapproved (Reason) </span> <span style="font-size: x-large; line-height: 0%;">□ </span> </div> <div style="display: flex; align-items: center; gap: 10px;"> <span>Approved </span> <span style="font-size: x-large; line-height: 0%;">□ </span> </div> </div> <div style="width: 30%; font-weight: bold;"> Stamp </div> </div> <p dir="ltr" style="text-align: left;"> Name of the responsible person: </p> <p dir="ltr" style="text-align: left;"> Functional center: </p> <p dir="ltr" style="text-align: left;"> Authorized signature and date: </p> <hr style="margin: 0; padding: 0;"> <p> <h4>The Higher Industrial Security Commission (Central Security Licenses Unit) </h4> <div style="display: flex; justify-content: space-between;"> <div style="width: 30%; font-weight: bold;"> Stamp </div> <div style="display: flex; align-items: center; margin-bottom: 10px; justify-content: end; gap: 15px;"> <div style="display: flex; align-items: center; gap: 10px;"> <span>Disapproved (Reason) </span> <span style="font-size: x-large; line-height: 0%;">□ </span> </div> <div style="display: flex; align-items: center; gap: 10px;"> <span>Approved </span> <span style="font-size: x-large; line-height: 0%;">□ </span> </div> </div> </div> <p dir="ltr" style="text-align: left;"> Name of the responsible person: </p> <p dir="ltr" style="text-align: left;"> Functional center: </p> <p dir="ltr" style="text-align: left;"> Authorized signature and date: </p> <hr style="margin: 0; padding: 0;"> <small>Important Note: This form is to be filled out on the imported company's letterhead and its data should be printed. Handwriting is not allowed, and any modification, addition, or scratching is prohibited. </small> </p> </div> </div> <style> /* @page { size: 8.27in 11.69in; margin: 5px !important; } */ </style>