SCHEDULE – I

[See regulation 4(2)]

Application for Authorisation

(All necessary documents shall be attached with the application for its acceptance)

Pakistan Environmental Protection Agency, Islamabad

APPLICATION FOR AUTHORISATION TO MANUFACTURE, IMPORT, OR USE

POLYTHENE FLAT BAGS IN ICT
Authorisation application no.
(for office use only)
Part – I DETAILS OF THE APPLICANT
Name of applicant
Designation/Position
Firm/Company Name
Business registration no. (if any)
Sales Tax No. / NTN
Corresponding Address
Telephone No. Cell No.
Email address

Part – II CATEGORY
Please tick the category for which applying:
(a) Manufacturer (b) Importer (c) User [As defined in regulations 4(1)]

Nature of polythene flat bags for which authorisation is sought:

□ Industrial packing □ Hospital waste □ Municipal waste
□ Primary industrial packing □ Hazardous waste □ Other (please specify)

Expected duration of the use or consumption:

Take back mechanism to be put in place (Note: Manufacturers and importers of polythene flat
bags to enclose detailed recycling plan, as defined in regulations 7):

ADDITIONAL DETAILS:
TO BE FILLED-IN BY POLYTHENE BAG MANUFACTURERS ONLY:
(a) Destination of polythene flat bags to be produced □ Local □ International
(b) Estimated quantity of polythene flat bags to be manufactured per year
(c) Different types of polythene flat bags to be produced
For Polythene Bag NON-MANUFACTURER (i.e. USER/IMPORTER) only:
(a) Source of product (Please mention name, mailing address, email and contact details of
supplier of polythene flat bags)

(b) Estimated quantity of polythene flat bags to be imported/used per year

(c) Different types of products to be packaged in polythene bags (for industrial and primary
industrial users)

Part – III AUTHORISATION FEE DETAILS (please attach the original

challan)
15. Authorisation fee details:
Bank Name Bank Branch Name
Fees Amount (in figures)
(in words)

Part – IV DECLARATION BY THE APPLICANT:

I, hereby certify that the particulars given above are correct and true to the best of my
knowledge and belief. I understand my authorisation may be suspended, varied or
cancelled if any information given above is false, misleading, wrong or incomplete.
Name
Designation/Position

CNIC Signature
Date

Company or Entity Name and Seal & Stamp

Part – V FOR OFFICIAL USE ONLY

Approval Status □ Approved □ Not approved

Comments

Officer Name Signature

Date Stamp
Please return the filled-in Application Form for Authorisation to Pakistan Environmental
Protection Agency (Pak-EPA) along with a cover letter and requisite documents listed
below. The application should be addressed to:

Director General
Pakistan Environmental Protection Agency
Plot 42, Street 6, H-8/2, Islamabad
dg@environment.gov.pk

Checklist of requisite documents to be submitted along with the Authorisation Application:

□ Cover letter addressed to Director General, Pak-EPA
□ Duty attested photocopy of CNIC of applicant
□ Duty attested photocopy of valid Sales Tax Number/NTN number issued by
FBR
□ Duly attested copy of NOC/certificate from relevant food authority certifying
use of food-grade polythene flat bags for primary industrial packing of edible
products (required only for food/catering industry).
□ Copy of agreement with a third-party regarding recycling and/or final disposal
of used polythene flat bags (if any).
□ Copy of third-party agreement with manufacturer/supplier (in case of user) or
user/distributer (in case of importer/manufacturer) of polythene flat bags
□ Detailed Recycling Plan as per regulations 7 of the subject Regulation (only in
case of manufacturer and importer).
□ Authorisation fees: Pay Order / Demand Draft of Rs. 10,000/- in favour of
Director General, Pakistan Environmental Protection Agency (Pak-EPA).

NOTE that the application fee shall be levied on every type of product
produced (in case of manufacturer) or packaged (in case of industry).