Ref. No.		
Details about export calendar year	
YEAR		
1 January  to  31 December			
	
Receivers, and applicable quantities	
	
	CONVERTER		ESTIMATED AMOUNT OF UOC (in tonnes)		

					

	

	ASNO use only	
Applicant’s signature, and permit details	Receiver has confirmed safeguards will apply		
	Approved:	____/____/______

__________________________
For Director General ASNO	
Name :				
		
Position:				
	Signature:	_______________________________	Date: ____/____/_______		
	Serial No.
___________________	
	Faxed to DRET		
	
Name of Permit Holder:		Permit number:			

Explanatory Notes

Ref No		A sequential reference number is required for each form of this type submitted by the Permit Holder (eg 001, 002, 003 etc). Where amendments are made to a previously submitted form, please use the same reference with a sequential revision number (eg 2005-003 Rev 1)	
Applicant’s Signature		
This form must be signed by a representative of the Permit Holder (i.e. the organisation) who will take responsibility and sign documents on behalf of the organisation.	

This form replaces the following form 	ASO140 (Original – issued 9 December 2008).