Hydro Power Plant Construction Application Form

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Hydro Power Plant Construction Application Form Powered By Docstoc
					                                                                                                                              Approved by the Government of Georgia
                                                                                                                              Approval        No.
                                                                               Hydro Power Plant
                                                                         Construction Application Form
                                                                                                       TariRi(dRe/Tve/weli) /Date (DD/MM/YYYY)              /      /

1. saerTo informacia /GENERAL INFORNATION
saxeli/Name

registrirebuli misamarTi/Registered Address

telefoni/Phone Number

faqsi/Fax Number

el.fosta/E-mail

veb-gverdi/URL

registraciis detalebi/ Registration Details:
(iuridiuli pirebisTvis/ for legal entities)
registraciis nomeri/Registration Number

qveyana/Country

TariRi/Date (DD/MM/YYYY)                                                         /           /

maregistrirebeli organo/Registration Authority

pasportis (an piradobis mowmobis) detalebi/       Passport (or Personal ID) details:
(fizikuri pirebisTvis / for individuals)

dabadebis TariRi/Date of Birth (DD/MM/YYYY)                                      /           /

piradobis damadasturebeli dokumenti/Identification Document                     pasporti/   Passport         piradobis mowmoba     /ID card          sxva/ Other

pasportis nomeri/Passport Number                                                                                       seria/ Series

gacemis TariRi/Date of Issue (DD/MM/YYYY)                                        /           /                 moqmedebis vada/    Expiration Date          /          /

gacemis adgili/Place of Issuance


2. informacia legaluri warmomadgenlis Sesaxeb /INFORMATION ON POWER OF ATTORNEY
saxeli da gvari/First and Last Name
dabadebis TariRi/Date of Birth (DD/MM/YYYY)                                      /           /
piradobis damadasturebeli dokumenti/Identification Document                     pasporti/   Passport         piradobis mowmoba     /ID card          sxva/ Other
pasportis nomeri/Passport Number                                                                                       seria/ Series
gacemis TariRi/Date of Issue (DD/MM/YYYY)                                        /           /                 moqmedebis vada/    Expiration Date          /          /
gacemis adgili/Place of Issuance


3. detaluri informacia samomavlod asaSenebeli eleqtro sadgurebis Sesaxeb                    /DETAILS ON THE PROSPECTIVE POWER PLANTS TO BE BUILT

dasaxeleba/Name
eleqtro sadguris nomeri/Number
adgilmdebareoba/Address

mTliani simZlavre - mgv / Total Capacity - MW

wliuri gamomuSavebis odenoba - mln kvt saaTi/Annual Generation - mln kwh
mSeneblobis dawyebis TariRi/Date of Launching Construction                      (DD/MM/YYYY)             /         /

mSeneblobis dasrulebis TariRi/Date of Commissioning Construction                (DD/MM/YYYY)             /         /
eqspluataciaSi gaSvebis TariRi/Date of Commencement of Operations               (DD/MM/YYYY)             /         /


dasaxeleba/Name
eleqtro sadguris nomeri/Number
adgilmdebareoba/Address

mTliani simZlavre - mgv / Total Capacity - MW
wliuri gamomuSavebis odenoba - mln kvt saaTi/Annual Generation - mln kwh
mSeneblobis dawyebis TariRi/Date of Launching Construction                      (DD/MM/YYYY)             /         /

mSeneblobis dasrulebis TariRi/Date of Commissioning Construction                (DD/MM/YYYY)             /         /
eqspluataciaSi gaSvebis TariRi/Date of Commencement of Operations               (DD/MM/YYYY)             /         /


dasaxeleba/Name
eleqtro sadguris nomeri/Number
adgilmdebareoba/Address

mTliani simZlavre - mgv / Total Capacity - MW

wliuri gamomuSavebis odenoba - mln kvt saaTi/Annual Generation - mln kwh
mSeneblobis dawyebis TariRi/Date of Launching Construction                      (DD/MM/YYYY)             /         /

mSeneblobis dasrulebis TariRi/Date of Commissioning Construction                (DD/MM/YYYY)             /         /
eqspluataciaSi gaSvebis TariRi/Date of Commencement of Operations               (DD/MM/YYYY)             /         /
dasaxeleba/Name
eleqtro sadguris nomeri/Number
adgilmdebareoba/Address

mTliani simZlavre - mgv / Total Capacity - MW

wliuri gamomuSavebis odenoba - mln kvt saaTi/Annual Generation - mln kwh
mSeneblobis dawyebis TariRi/Date of Launching Construction                                   (DD/MM/YYYY)                    /           /

mSeneblobis dasrulebis TariRi/Date of Commissioning Construction                             (DD/MM/YYYY)                    /           /
eqspluataciaSi gaSvebis TariRi/Date of Commencement of Operations                            (DD/MM/YYYY)                    /           /


dasaxeleba/Name
eleqtro sadguris nomeri/Number
adgilmdebareoba/Address

mTliani simZlavre - mgv / Total Capacity - MW

wliuri gamomuSavebis odenoba - mln kvt saaTi/Annual Generation - mln kwh
mSeneblobis dawyebis TariRi/Date of Launching Construction                                   (DD/MM/YYYY)                    /           /

mSeneblobis dasrulebis TariRi/Date of Commissioning Construction                             (DD/MM/YYYY)                    /           /
eqspluataciaSi gaSvebis TariRi/Date of Commencement of Operations                            (DD/MM/YYYY)                    /           /


dasaxeleba/Name
eleqtro sadguris nomeri/Number
adgilmdebareoba/Address

mTliani simZlavre - mgv / Total Capacity - MW
wliuri gamomuSavebis odenoba - mln kvt saaTi/Annual Generation - mln kwh

mSeneblobis dawyebis TariRi/Date of Launching Construction                                   (DD/MM/YYYY)                    /           /

mSeneblobis dasrulebis TariRi/Date of Commissioning Construction                             (DD/MM/YYYY)                    /           /
eqspluataciaSi gaSvebis TariRi/Date of Commencement of Operations                            (DD/MM/YYYY)                    /           /


dasaxeleba/Name
eleqtro sadguris nomeri/Number
adgilmdebareoba/Address

mTliani simZlavre - mgv / Total Capacity - MW
wliuri gamomuSavebis odenoba - mln kvt saaTi/Annual Generation - mln kwh
mSeneblobis dawyebis TariRi/Date of Launching Construction                                   (DD/MM/YYYY)                    /           /

mSeneblobis dasrulebis TariRi/Date of Commissioning Construction                             (DD/MM/YYYY)                    /           /
eqspluataciaSi gaSvebis TariRi/Date of Commencement of Operations                            (DD/MM/YYYY)                    /           /


4. investiciis moculoba/ INVESTMENT AMOUNT
mTliani investiciis moculoba/Total Investment Amount                                         aSS dolari/US$


vadastureb(T), rom gavecani(T) saqarTvelos energetikis saministros mier potenciuri alternatiuli wyaroebis nusxaSi Semavali asaSenebeli eleqtrosadgur(eb)is
mSeneblobis, operirebisa da flobis Sesaxeb interesTa gamoxatvas, survili (gv)maqvs monawileoba miviRo(T) aRniSnul interesTa gamoxatvaSi.



By signing this Application Form, we (I) hereby confirm that, we (I) have interpreted and agreed to the terms and conditions set out in the announcement of the Ministry of Energy of Georgia on expression of interest for
the construction, operation and ownership (BOO) of power plants and hereby express interest.

danarTi /APPENDIX
ganacxads Tan erTvis Semdegi dokumentebi/Application must be put forward with the following documentations enclosed:

iuridiuli piris SemTxvevaSi /For legal entities                                                                                          TandarTulia /Enclosed                     xelmiuwdomelia /Not applicable

a. wesdebis asli, damowmebuli notariusis mier/Notarized copy of the company charter

c. ZalaSi myofi samewarmeo reestris amonaweri an misi Semcvleli dokumenti/
   Certificate of Incorporation of the company
b. aRmasrulebeli direqtoratis daniSvnis (arCevis) rezolucia/
   Resolution appointing/electing the executive body of the company
h. uflebamosili piris uflebis damadasturebeli dokumenti/
   Power of Attorney
g. finansuri uwyebebi - auditoruli daskvna (IFRS, US GAAP, other)
   Financial statements – annual report and consolidated financial statements with auditors’ report (IFRS, US GAAP, other)
fizikuri pirebisaTvis/ For individuals
a. pasportis an piradobis mowmobis asli/Copy of passport or other ID documents

xelmowera /SIGNATURE



                                                                                                                             TariRi/DATE (DD/MM/YYYY)                                /           /




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