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					ETS 11 Application for Surrender of a Permit
Version 2, 30 August 2008
                    The Greenhouse Gas Emissions Trading Scheme Regulations 2005
Confidentiality Statement
The information submitted in respect of this notification will be subject to public access to information requirements, including the
Environmental Information Regulations 2004. If you consider that any information you provide in connection with your application should be
treated as commercially confidential, please let us know. You should be aware that under the provisions of the Freedom of Information Act
2000 and regulations made under it, the Industrial Pollution and Radiochemical Inspectorate may be obliged to disclose information even
where the applicant requests that it is kept confidential.

Introduction to this form
This form is to be used for all applications, under regulation 16(1), for the surrender of a greenhouse gas emissions trading permit

This form (ref: ETS11) guides you through the Regulator's requirements for an application for a surrender of a permit by requiring you to
respond to a series of questions and provide explanation where necessary. In this way you and we can be sure that all and only the
necessary information is provided.

Completion of the Form
This form has been designed in Microsoft Excel to allow it to be filled in electronically. Once completed, you should e-mail it to the Chief
Inspector at
We recommend that any additional information should be submitted in a separate e-mail to this form in order to avoid potential delivery
problems. This form and the additional information may be submitted as hard copy but we encourage you to submit your notification
electronically as this will be the most effective method of ensuring that your notification ahs been received and will be processed quickly.

A determination fee of £620 is payable as part of an application for a surrender. Please make cheques payable to the ‘Department of the
Environment, General Account’.
If the application is sent by email, the cheque must be sent by post to the address provided in section B3 along with the operator name,
installation name and date of application. Please write your ETS permit no. and NAP No. on the back of your cheque.

Operators should note that the Inspectorate will not determine any application for a variation unless the appropriate fee has been received.

Additional Information
Any additional documents that you want to submit as part of this notification need to be identified in the form (Section B2) with a file name (if
submitted electronically) or document reference number (if submitted as a hardcopy).

We can accept additional information in the following formats:
- Microsoft Word
- Microsoft Excel
- Adobe Acrobat pdfs

If you need help and advice
We have made this form as straightforward as possible but please contact us if you need any advice on how to set out the information we

You can contact us by email on
                                                  For CA Use Only                                                                      PG1

                                                  CA Reference Number
                                                  CA Date Received
                                                  CA Date Approved & signature

A1     About your installation
A1.1   What are your emissions trading permit and National Allocation Plan numbers?
       Please use the numbers stated on your ETS permit.

           ETS -                                                               Emissions trading permit number
                                                                               National Allocation Plan (NAP) Number (if
A1.2   What is the Operator name?
       Please use name stated within the ETS permit.
                                                                               Operator Name

A1.3   What is the name of the installation and the site on which it is located?
       Please use name stated within the ETS permit.
                                                                               Installation name
                                                                               Site name

A1.4   What is the date of this application?
       Please enter date of submission to the Industrial Pollution and Radiochemical Inspectorate

       Day (dd)      Month (mm)    Year (yyyy)

A2     About your surrender of permit
A3.1   On what date did the carrying out of all Schedule 1 activities authorised by the greenhouse
       gas emissions permit cease?

       Day (dd)      Month (mm)    Year (yyyy)
       Please tick which apply:

A3.2   Please describe the change that has resulted in the cessation of all Schedule 1 activities.
       Evidence must be provided to demonstrate that a Schedule 1 activity is no longer carried out and any supporting
       documentation must be referenced in section B2.
       Evidence could include reference to announcements in local press of closure of the installation and/or surrender of essential
       permits e.g. PPC permit.

A3    Authorised contacts
     It will help us to have someone who we can contact directly with any questions about your application. The person you name
     should have the authority to act on your behalf. This could be an agent rather than the Operator.



                                                               Street address


                                                               Phone number
                                                               Fax number
                                                               Email address

B1   Data protection notice
     The Data Protection Act 1998 requires that the Department of the Environment advise its customers how data relating to
     individuals will be processed and disclosed.

     The information provided by yourselves will be processed by the Industrial Pollution and Radiochemical Inspectorate to deal
     with your application, to monitor compliance with permit conditions and for maintaining the registry. We may also process
     and/or disclose it in connection with the following:

     · offering/providing you with our literature/services relating to environmental matters;
     · consulting with the public, public bodies and other organisations (e.g. Health and Safety Executive Local Authorities,
     Emergency Services, DEFRA) on environmental issues;
     · carrying out statistical analysis, research and development on environmental issues;
     · providing public register information to enquirers;
     · investigating possible breaches of environmental law and taking any resulting action;
     · preventing breaches of environmental law; and
     · assessing customer service satisfaction and improving our service.

     We may pass it on to our agents/representatives to do these things on our behalf.

     Individuals have a right to see the information we hold about them. We will correct it if it is inaccurate. You should ensure that
     any person named in this application (including supporting information) is informed of the content of this Data protection Notice.

B2   Additional Information
     If you are providing any other information that you wish us to take into account please tell us here. Please provide this
     information in an electronic format wherever possible. You can provide information as Microsoft Word, Excel, and Adobe
     Acrobat formats.
     Please avoid supplying non-relevant information as it can slow down the processing of your application. Additional
     documentation provided should be clearly referenced, and the file name / reference number provided below.
     Please provide file name(s) (if in an electronic format) or document reference number(s) (if hard copy) below:

     File name or reference                     Document description

B3   What next?
     Now please return this form by email or post, together with all supporting information and payment to:

     If posting, send one copy to:

     Emissions Trading, Industrial Pollution and Radiochemical Inspectorate, 1st Floor, Klondyke Building,
     Gasworks Industrial Park, Cromac Avenue, Lower Ormeau Road, Belfast, BT7 2JA

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