<p> PDA 2 www.mida.gov.my (03.01.2013)</p><p>APPLICATION FOR PERMIT UNDER THE PETROLEUM DEVELOPMENT ACT, 1974</p><p>Application for: [tick () whichever is relevant]</p><p>(i) Refining crude petroleum</p><p>(ii) Manufacturing petroleum and/or petrochemical products</p><p>(iii) Processing of natural gas</p><p>Proposed products/activities Tariff code no. Incentives Approved By Other Government Agencies</p><p>A. PARTICULARS OF APPLICANT COMPANY</p><p>1. Name of applicant/company and correspondence address PDA 2</p><p>Fax Contact Person Telephone Designation </p><p>2(i) Name of company which will undertake the project</p><p>2(ii) Date of incorporation </p><p>2(iii) Address of registered office</p><p>Fax Telephone </p><p>3. Proposed factory location</p><p>4. Particulars of directors</p><p>Name and residential address Nationality % shares held in the company</p><p>2 PDA 2</p><p>B. PROJECT COST</p><p>Phase I Phase 2 Total RM RM RM 1. Fixed assets (a) Land (specify area) (b) Factory building (specify built-up area) …………………………………………… (c) Plant and machinery (d) Other equipment</p><p>Total fixed assets 2. Pre-operational expenditure 3. Working capital</p><p>Total </p><p>Note If the land, factory building, plant and machinery are to be rented/leased, indicate the annual cost of : rental/lease</p><p>C. FINANCING</p><p>RM % 1. Authorised capital 2. Shareholders’ funds (a) Paid-up capital (a) Malaysian individuals</p><p>Bumiputera</p><p>Non-Bumiputera (b) Companies incorporated in Malaysia*</p><p>(c) Foreign individual/company (Specify name and country)</p><p>Total of (a), (b) and (c) 100%</p><p>3 PDA 2</p><p>* For 2(b), provide equity structure as follows:</p><p>Name of company: Name of company:</p><p>% % Bumiputera Bumiputera</p><p>Non-Bumiputera Non-Bumiputera</p><p>Foreign Foreign</p><p>RM 3. Loan Domestic</p><p>Foreign </p><p>Total 4. Other sources (Please specify):</p><p>Total</p><p>Total of 2, 3 and 4</p><p>4 PDA 2</p><p>D. MANPOWER</p><p>Please fill in where relevant Please note that the information is required to enable the government to undertake the appropriate manpower planning to meet the specific manpower needs of companies proposing to establish projects in Malaysia.</p><p>Full-time employment Malaysian Foreign national Category Diploma/ Diploma/ Total Degree Others Degree Others Certificate Certificate</p><p>1. Managerial staff with</p><p>(a) Technical qualifications (i) Electrical & Electronics Engineering (ii) Mechanical Engineering (iii) Chemical Engineering (iv) Others (Please specify):</p><p>(b) Science qualifications (i) Chemistry (ii) Physics (iii) Biotechnology / Microbiology (iv) Pharmacy (v) Computer Science (vi) Others (Please specify):</p><p>(c) Other qualifications / experience (e.g. economics, marketing, finance & accounting. Please specify):</p><p>2. Technical and supervisory staff with</p><p>(a) Technical qualifications (i) Electrical & Electronics Engineering (ii) Mechanical Engineering (iii) Chemical Engineering (iv) Others (Please specify):</p><p>Note:</p><p>* If there is more than one factory location, please provide the same information on a separate sheet of paper</p><p>5 PDA 2</p><p>Full-time employment Malaysian Foreign national Category Diploma/ Diploma/ Total Degree Others Degree Others Certificate Certificate (b) Science qualifications (i) Chemistry (ii) Physics (iii) Biotechnology / Microbiology (iv) Pharmacy (v) Computer Science (vi) Others (Please specify):</p><p>(c) Other qualifications / experience</p><p>Craft skills (i) Plant maintenance mechanic (ii) Tool & die maker (iii) Machinist (iv) IT personnel (Including CAD/CAM designer & DCS operator) (v) Quality Controller (vi) Electrician (vii) Chargeman (viii) Welder (ix) Other special skills related to the sector (Please specify): a) b) c) d) e) f) g)</p><p>3. (a) Sales and clerical (b) Other general workers 4. Machine operators and assemblers** Total</p><p>Note: ** Machine operators and assemblers are those involved in the production/assembly line who receive mainly on the job training for a period between 3 to 6 months,e.g. production operators</p><p>1. Percentage of science and technical staff having degrees or diplomas with a minimum of 5 ______years experience (of the total workforce) : %</p><p>2. Number of Staff with Post Graduate (ie. Masters/PhD etc) qualifications : ______</p><p>3. In addition to the full-time employees as mentioned in the above tables, please provide the ______number of workers which are outsourced (not under the company’s payroll) :</p><p>6 PDA 2</p><p>E. EMPLOYMENT BY INCOME</p><p>Number of Persons Employed by Average Monthly Salary* (RM) 5,000- 10,000 and <3,000 3,000-<5,000 <10,000 above</p><p>Foreign Foreign Foreign Foreign Malaysian Malaysian Malaysian Malaysian National National National National 1. Managerial and Professional</p><p>2. Technical and supervisory staff with (a) Engineering/Technical qualifications</p><p>(b) Science qualifications</p><p>(c) Other qualifications / experience</p><p>Craft skills such as plant maintenance mechanic, tool & die maker, machinist, IT personnel (including CAD/CAM designer & DCS operator), Quality Controller, Electrician, Chargeman, Welder)</p><p>3. (a) Sales and clerical (b) Other general workers</p><p>4. Machine operators and assemblers**</p><p>Total</p><p>Note:</p><p>* include wages, salaries, bonuses, social insurance contribution and all employee benefits.</p><p>If there is more than one factory location, please provide the same information on a separate sheet of paper.</p><p>** Machine operators and assemblers are those involved in the production/assembly line who receive mainly on-the-job training for a period between 3 to 6 months,e.g. production operators.</p><p>7 PDA 2</p><p>F. MANUFACTURING PROCESS AND POLLUTION CONTROL</p><p>1. Provide the manufacturing process flow chart and explain the major processes. Indicate processes according to type of machinery used as follows:</p><p>R - for robotic machinery</p><p>A - for automatic machinery</p><p>S - for semi-automatic machinery</p><p>M - for manual operation</p><p>2. From the process flow chart, provide details on emission of pollutants</p><p>(i) Point of emission (ii) Type of pollutants (iii) Quantity</p><p>G. MAJOR MACHINERY AND POLLUTION CONTROL EQUIPMENT</p><p>1. Machinery and equipment</p><p>New or Country of Cost Description Type* Unit Function used origin RM</p><p>Note:</p><p>* Indicate</p><p>R - for robotic machinery A - for automatic machinery S - for semi-automatic machinery M - for other machinery</p><p>8 PDA 2</p><p>2. Pollution control equipment</p><p>New or Country of Cost Description Unit Function used origin RM</p><p>H. SOURCES OF TECHNICAL KNOW-HOW</p><p>Relationship with applicant Years of Name and address of supplier (e.g. machinery supplier, experience parent/associate company)</p><p>9 PDA 2</p><p>I. PRODUCTION</p><p>1. Date of commencement of production ………………………………………………….</p><p>2. Production schedule</p><p>Products Year 1 Year 2 Year 3 Maximum annual production Quantity Ex-factory Quantity Ex-factory Quantity Ex-factory capacity value value value per 8-hour shift RM RM RM</p><p>Total</p><p>* Unit as given in ‘The Malaysian Trade Classification and Customs Duties Order’</p><p>10 PDA 2</p><p>J. MARKET AND DISTRIBUTION</p><p>1. Market</p><p>Products % market Principal consumers and export destinations Year 1 Year 2 Year 3</p><p>For local market</p><p>For FZ/LMW market</p><p>For export market</p><p>* Free Zone/Licenced Manufacturing Warehouse</p><p>11 PDA 2</p><p>2. Current market size and rate of growth</p><p>Total Market size Company’s market Projected rate Share ** of growth Quantity* % Products %</p><p>Malaysia World Malaysia World Malaysia World</p><p>* Units as given in ‘The Malaysian Trade Classification and Customs Duties Order’</p><p>** Applicant and/or its related companies</p><p>3. Other principal manufacturers in the world</p><p>Products Market share % Name and factory location Malaysia World</p><p>4. Describe the distribution system proposed for the local market</p><p>12 PDA 2</p><p>K. MAJOR RAW MATERIALS AND COMPONENTS</p><p>Value per Source annum Raw materials Quantity per RM and components % Value annum Name and address of major suppliers</p><p>Local Import</p><p>* Units as given in ‘The Malaysian Trade Classification and Customs Duties Order’</p><p>13 PDA 2</p><p>L. PRODUCT PRICING</p><p>Item % ex-factory price for each product</p><p>Products ……………………………………………</p><p>(i) Cost of imported raw materials/components</p><p>(ii) Cost of local raw materials/components</p><p>(iii) Cost of energy and fuel</p><p>(iv) Cost of labour</p><p>(v) Depreciation</p><p>(vi) Interest payments, indirect taxes, quit rent etc</p><p>(vii) Administrative and marketing cost</p><p>(viii) Cost of technology (includes royalty, management services and other related costs)</p><p>(ix) Manufacturing profit</p><p>Total 100%</p><p>14 PDA 2</p><p>M. ESTIMATED LABOUR COST AND EARNINGS</p><p>A. ESTIMATED LABOUR COST - Salaries and Wages*</p><p>Year in Operation Year 1 Year 2 Year 3</p><p>Salaries and Wages (RM)</p><p>Note:</p><p>*Include wages, salaries, bonuses, social insurance contribution and all employee benefits</p><p>B. ESTIMATED EARNINGS</p><p>Year in Operation Year 1 Year 2 Year 3</p><p>(a) Estimated Earnings before Interest, Tax, Depreciation & Amortization (EBITDA) (RM)</p><p>(b) Estimated Net Income After Tax (RM)</p><p>- Held in Malaysia as reserves (%)</p><p>- Remitted out of Malaysia (%)</p><p>- Reinvested in Malaysia (%)</p><p>15 PDA 2</p><p>N. DECLARATION</p><p>I , , the Managing Director of</p><p>(i) hereby declare that to the best of my knowledge, the particulars furnished in this application are true.</p><p> have engaged/is planning to engage the services of the following consultant for my (ii)* application :</p><p>Company Name : Address :</p><p>Contact Person : Designation : Telephone no. : Fax no. : E-mail :</p><p>I take full responsibility for all information submitted by the consultant(s).</p><p>Date (Signature)</p><p>(Company’s Stamp or Seal)</p><p>*Please complete this section if the company has engaged/is planning to engage the services of consultant(s) to act on behalf of the company. Please provide information on a separate sheet of paper if space is insufficient</p><p>16</p>