Application for One-Time Waste Disposal Permit
ID Card No
Building Entry Point Name
Form GBR 12.5
Environment and Resources AuthorityEnvironmental Permitting UnitHexagon House, Spencer Hill,Marsa MRS 1441 Malta
The requested information must be completed in full. Failure to provide adequate information will delay processing of the application.
For Office use only
Reference Number (OTD)
Registration Number (Number plate)
Location of waste disposal site
Personal details of applicant or contact person
Details of Company or institution on behalf of which the application is being made
Registered Company Name
Company Registration Number
Note: Application form for one-time waste disposal permit is subject to approval by ERA. Permit must be presented and signed by the waste disposal site manager. Once waste is transferred, permit must be returned back to ERA as a confirmation of receipt of wastes.
1. Further information (to be filled in by applicant)
1.1 Type of material
Note: Transport and disposal of any other type of waste should only be carried out through a licensed waste carrier (a separate permit should be issued by ERA)
Non - Hazardous Material
Materials as identified for destruction by Police
1.2 Kindly give a description and the origin of waste to be transported and disposed of including the quantity of waste.
1.3 EWC codes for which you are applying in your permit
EWC 02 02 Wastes from the preparation of meat, fish and other foods of animal origin
02 02 03 materials unsuitable for consumption or processing
EWC 02 03 Waste from fruit, vegetables, cereals, edible oils, cocoa, coffee, tea and tobacco preparation and processing; conserve production, yeast and yeast extract production, molasses preparation and fermentation
02 03 04 materials unsuitable for consumption or processing
EWC 02 05 wastes from the dairy products industry
02 05 01 materials unsuitable for consumption or processing
EWC 02 06 wastes from the baking and confectionery industry
02 06 01 materials unsuitable for consumption or processing
EWC 02 07 wastes from the production of alcoholic and non - alcoholic beverages (except coffee, tea and cocoa)
02 07 04 materials unsuitable for consumption or processing
EWC 07 05 Wastes from the MFSU of pharmaceuticals
07 05 13 solid wastes containing dangerous substances
07 05 14 solid wastes other than those mentioned in 07 05 13
07 05 99 wastes not otherwise specified
Other EWC codes not specified (kindly insert a six (6) digit number)
Titles of supplementary forms and documentation to be submitted
Tick when provided
Copy of a valid vehicle license or registration certificate issued by TM
Declaration from waste disposal site confirming the acceptance of the waste
Copy of disposal/destruction order by entity requiring action
Insert further documents as applicable
NB: The Authority may request any additional information it deems necessary for further process the application.
I apply for the environmental registration as indicated above, and declare that, to the best of my knowledge, all the information contained in this application and on the submitted supplementary forms and documentation is complete and correct. I also understand that any incomplete, fraudulent or misleading information will annul the application or permit, and may also incur any relevant penalties. I also declare that I have read the data protection clause below
on behalf of/in my own name (in block letters)
Please read Data Protection Clause on next page before signing.
Data Protection Clause
In terms of the Data Protection Act (Chapter 440 of the Laws of Malta), we will process any personal and/ or sensitive data supplied on/ in this application, request or notification form or subsequently supplied by yourself, whether orally or in writing, for all or any of the following:1. The proper processing of your application, request and/or notice as submitted; 2. verification of the information provided to our officers; 3. Preventing, detecting and/or prosecuting fraud and any other criminal activity which the Authority is bound to report and/or act upon whilst meeting any other specific legal or regulatory obligations;4. Establishing, exercising or defending any legal action;5. Internal management, research and statistics, systems administration, the development and improvement of our services;
6. the protection and promotion of our legitimate interests and the proper conduct of our obligations arising under any law or statutory instrument; and7. to make public the necessary information as specified in the relevant law and/or instrument.Relevant data will be disclosed or shared as appropriate with all our employees and with other third parties if pertinent to any of the purposes listed above.Every field on the form is mandatory. Should you fail to fill in any mandatory field, we reserve the right to refuse the application. Should any field be inapplicable to your particular circumstances please mark that field with the letters “N/A”.
You have the right to require that we provide you with access to your personal data as well as the right to rectify, or, in appropriate circumstances, erase/edit any inaccurate, incomplete or immaterial personal data which is being processed. However, you are required to inform us immediately of any alterations relating to your personal data which we are processing.By signing this form, you confirm that you are giving your explicit consent, in terms of the Data Protection Act, on behalf of yourself and all the other persons specified in this form for the Authority to process your respective personal information as outlined above and you confirm that you have brought this Data Protection notice to the attention of these other persons and obtained their respective consents.We undertake to implement appropriate measures and safeguards for the purpose of protecting the confidentiality, integrity and availability of all data processed.
Approval by ERA
The Authority hereby grants a One-time Emergency Waste Disposal Permit in accordance with the application conditions and regulations specified. This permit is valid for three (3) months from the date of issue.
Acknowledgement of Receipt of Waste
I hereby declare the receipt of waste subject to a One-time Emergency Waste Disposal Permit approved by ERA
Name of TCP