Fillable APPLICATION FOR AMENDMENT TO PETROLEUM PRODUCTS DISTRIBUTION LICENSE (Prince Edward Island Regulatory & Appeals Commission)

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APPLICATION FOR AMENDMENT TO PETROLEUM PRODUCTS DISTRIBUTION LICENSE (Prince Edward Island Regulatory & Appeals Commission)

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APPLICATION FOR AMENDMENT TO PETROLEUM PRODUCTS DISTRIBUTION LICENSE
1
CORPORATE NAME OF WHOLESALER:
NEW CORPORATE NAME (IF APPLICABLE):
2
DOING BUSINESS AS (IF DIFFERENT FROM ABOVE):
3
ADDRESS: Street Town, Community
Province Postal Code Telephone
4
COMPLETED BY:
FULL NAME (please print):
SIGNATURE:
TITLE:
TELEPHONE:
EMAIL:
DATE:
5
DETAILS ON PROPOSED CHANGES TO THE FOLLOWING (IF APPLICABLE) MUST ACCOMPANY THE APPLICATION:
- DESCRIPTION OF PRODUCTS TO BE SOLD - BRAND NAME TO BE ASSOCIATED WITH THE PRODUCTS
- SUPPLY ARRANGEMENTS - PROPOSED DATE OF CHANGES
- PROPOSED DISTRIBUTION NETWORK - ESTIMATION OF POTENTIAL ANNUAL SALES VOLUMES
6
LICENSE AMENDMENT FEE AS OUTLINED IN THE CURRENT LICENSE SECTION FOUND ON THE COMMISSION’S PUBLIC WEBSITE
PAYABLE TO THE COMMISSION.
7
RETURN COMPLETED FORM TO:
ISLAND REGULATORY AND APPEALS COMMISSION
134 KENT STREET, P. O. BOX 577
CHARLOTTETOWN, PE
C1A 7L1
TEL: 902-892-3501
TOLL FREE (NS & PEI): 1-800-501-6268
FAX: 902-566-4076
LICENSE FEES PAYABLE TO “ISLAND REGULATORY AND APPEALS COMMISSION”
Information on this Form is collected pursuant to the Petroleum Products Act and will be used by the Commission in the administration of the said
Act. For additional information, contact the Commission at 902-892-3501 or by email at info@irac.pe.ca.
IRAC516(2019)
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APPLICATION FOR AMENDMENT TO PETROLEUM PRODUCTS DISTRIBUTION LICENSE (Prince Edward Island Regulatory & Appeals Commission)

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Completed 24 July 2021

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