e-form Control of Major Accident Hazards
(COMAH) - Part B
Non-Statutory information required by the Competent Authority and statutory information not to be disclosed to the Public
(COMAH) Regl. L.N. 179/2015 - Part B Name of the Operator Address of the Operator (Include Registered Office Address) Address of the Establishment Concerned (if different from above) DETAILS FOR INVOICING Contact Name (if different from above) Position Operators of COMAH establishments may be charged for work carried out by the competent Authority in implementing the regulations Invoicing Company Name Company Address

REASON FOR NOTIFICATION Have you recently submitted a notification for the establishment? No Yes If Yes, provide date of submission Why are you submitting this Notification? Please tick where appropriate Reg. 5(2)(a) Prior to the start of construction or operation of a new establishment Reg. 5(2)(a) Prior to modifications leading to a change in inventory of dangerous substances of a new establishment Reg. 5(2)(b) For all other cases, one year from which these regulations apply to the establishment Reg. 5(4)(a) Significant increase or decrease in quantity of dangerous substances or significant change in nature or physical form
of the dangerous substances Reg. 5(4)(b) Modifications which could have significant consequences in terms of major accident hazards Reg. 5(4)(c) Permanent closure of the establishment or is decommissioning Reg. 5(4)(d) Change in name, trade, address of the operator, name and position of person in charge NATIONAL SECURITY Is there any information that you believe should not be disclosed to the public? Certain information may be excluded from being supplied to the public where the conditions laid down in Article 4 of Directive 2003/4/EC are fulfilled. If you believe that this applied to information about your establishment select Yes No Yes Does the notification form Part A contain any national security information that would prevent it from being disclosed to the public? No Yes

COMMERCIAL AND PERSONAL CONFIDENTIALITY Do you wish any information not to be disclosed to the public because it is commercially or personally confidential? No Yes If Yes, then you should: Complete Part A form excluding the commercially or personally confidential information and enter int he text below all the information which you do not wish to be disclosed to the public DECLARATION I certify that the information in this Notification Part B is correct Name and Surname Position Telephone Mobile Email Signature Date Please send the notification by email to mepi@ohsa.mt (MEPI Section).

The Authority will confirm receipt