Noc Format from Company for Vehicle - PDF

							    EHS-FHP-06                                                                                                              FHP-06a




                                             Shisha Permit Application Form

 Company Name
 License Number & Expiry Date                                                                          /
 Licensed Activity/ties
 Location/Shop Nos.
 Contact Number & Email address                                                                        /
 *Any Undertaking Letter Provided Earlier? (attach pdf format copy)                _____ Yes                        _____ No
 *Permit Application Type (for Renewal, attach latest Inspection Report)           _____ New                        _____ Renewal

 *Facility/Building Owner approval to practice Shisha valid and
                                                                                   _____ Yes                        _____ No
 available? (attach pdf format copy)
 *NAMAD/Property Mngt. Permit for Extra Operational Hours
                                                                                   _____ Yes                        _____ No
 valid and available? [from 12MN-3AM] (attach pdf format copy)
 *CLD Permit for Extra Operational Hours valid and available?
                                                                                   _____ Yes                        _____ No
 [from 12MN-3AM] (attach pdf format copy)
 *EHS Approved Drawing & AC/Ventilation (EHS NOC-BP)
                                                                                   _____ Yes                        _____ No
 (attach pdf format copy of these documents during application)
 *CED Building Completion Certificate
                                                                                   _____ Yes                        _____ No
 (attach pdf format copy of these documents during application)
 *EHS NOC for Activity Verification Inspection (AVI), valid?
                                                                                   _____ Yes                        _____ No
 (attach pdf format copy of these documents during application)

       I undertake that I shall adhere and comply with all existing and future applicable TRAKHEES-EHS rules and regulations
       pertaining to this Shisha Permit Application. I fully accept that TRAKHEES-EHS has the full discretion with the process
       outcome of this application. If Permit is issued, I fully accept that in case of committing any violation or complaint has
       been raised related to the scope of this permit and actual operation, TRAKHEES-EHS has all the right to take further action
       to my licensed establishment but not limited to penalty or immediate cancellation of this permit, without further notice.

 Authorized Signatory: __________________________________                                Date of Application: _________________
                            (Signature over Printed Name)

                                                 TRAKHEES-EHS Official Use Only
 Any pending EHS compliance or issues: YES___ NO ___                           Details: _______________________________
 Inspection Report/Undertaking Letter provided: YES__ NO __                    Ref. No.: ______________________________
 Actual Performed Activity Allowed:                                            Details: _______________________________
 Site Assessment Required: YES___ NO ___                                       Results: _______________________________
 Approved Shisha Permit Issuance:                                               YES___                           NO ___
 Reviewing Officer:
 (Name, Signature & Date)




 [Conditions, if any]                                                          [Approval Stamp and Date:]


  * Submit all marked [*] documents in scanned pdf format copy only in 1 CD to TRAKHEES-EHS Office (See Client Procedure EHS-FHP06)




Revision: 00                                               November 2010                                                       Page 1 of 1