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Application For Accreditation As Environmental Consultant Form

This document is an application form for accreditation as an environmental consultant with the National Oil Spill Detection and Response Agency (NOSDRA) in Nigeria. It requests basic information about the applicant's company such as name, address, contact details, areas of specialization, and years of operation. Financial information is also required, including bank details and references. The applicant must provide documents to support their application such as certificates of incorporation, tax clearance, evidence of past environmental jobs, and technical qualifications of personnel. The applicant declares the truth of the information provided and understands false information will result in disqualification.

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Akpevweoghene Kelvin Idogun
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1K views5 pages

Application For Accreditation As Environmental Consultant Form

This document is an application form for accreditation as an environmental consultant with the National Oil Spill Detection and Response Agency (NOSDRA) in Nigeria. It requests basic information about the applicant's company such as name, address, contact details, areas of specialization, and years of operation. Financial information is also required, including bank details and references. The applicant must provide documents to support their application such as certificates of incorporation, tax clearance, evidence of past environmental jobs, and technical qualifications of personnel. The applicant declares the truth of the information provided and understands false information will result in disqualification.

Uploaded by

Akpevweoghene Kelvin Idogun
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Business Details: Gathers specialized business information such as type of operations and areas of expertise for accreditation.
  • Basic Information: Collects essential details about the applying company, including name, contact details, and address.
  • Professional Qualifications: Requests information on the professional qualifications of potential environmental consultants.
  • Evidence of Environmental Jobs Executed: Requires documentation of past environmental jobs handled by the applicant to verify experience.
  • Financial and Supporting Details: Inquires about financial references and additional supporting documents that bolster the application.
  • Declaration: Contains a formal declaration affirming the accuracy of provided information and agreement to terms.

NATIONAL OIL SPILL DETECTION

AND RESPONSE AGENCY


(Establishment Act No. 15, 2006)
5th FLOOR, NAIC HOUSE, CENTRAL BUSINESS DISTRICT, ABUJA FCT

APPLICATION FOR
ACCREDITATION AS
ENVIRONMENTAL CONSULTANT
FORM.

NOSDRA/FORM NO................
DATE ........................................

1.

Basic Information

A.

Name of Company

B.

Business Address ....


.

C.

Postal Address ....


.

D.

Contact Details:
Telephone Number(s) ..
Fax Number ..
Email Address .

2.

Business Details
A.

Nature of Business ...


.

B.

Area(s) of Specialization for which Accreditation is sought:


(i)
Oil Spill Cleanup and Recovery
(ii)
Remediation and Rehabilitation of Past Impacted Sites
(iii)
Damage Assessment
(iv)
Post impact Assessment
(v)
Oil Spill Response Equipment & Material
(vi)
Environmental Laboratory services
(vii)
Oily Waste Handling and Management
Collection
Treatment
Disposal
(viii)
(vii)
Training
(viii)

Other (please specify) .

C.

Year & Location of Incorporation (kindly include the incorporation number)


......
..

D.

Principal Partner(s)
(i) ..
(ii) .
(iii) .
(iv) .

E.

Address of Principal Partner(s)

(i) .
(ii)
(iii) ..
(iv)
F.

Professional Qualification(s)
(i) .
(ii)
(iii) ..
(iv) ..

G.

Evidence of Environmental Jobs(s) Executed (including Name & Address of Client)


(detailed information may be attached on separate sheets)

(i) ..
...
...
(ii) ..
...
...
(iii) ..
...
...
(iv) ..
...
...
H.

Evidence of Additional Experience(s) (detailed information may be attached on separate sheets)


(i) ...
....
(ii) ..
..
(iii) ..
..

I.

List of Key Technical Personnel (kindly give at least 3)


(i) ..
(ii) ..
(iii) ..
(iv) ..
(v) ..
(vi) ..

J.

Special Technical Facilities of the Company, if any (optional)


...
...
...
...

3.

Financial Details

A.

Name & Address of Bankers ...


..

B.

Name & Addresses of 3 Referees


(i) ..
...
...
(ii) ..
...
...
(iii) ..
...
...

4.

Supporting Documents
Kindly attach copies of the following documents with the company profile:
(i)
(ii)
(iii)
(iii)
(iv)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)
(xii)

Formal application letter specifying area (s) of interest adressed to the DG/CE
NOSDRA
Company profile
Certificate of Incorporation
Memorandum of Association
3 years Current Tax Clearance Certificate
Tax Identification Number (TIN)
Evidence of Payment for Accreditation Form (N 10,000.00)
VAT Registration & Evidence of VAT Remittances
Experience/Technical Qualification & Experience of key personnel
Evidence of similar project/past work done including reference letter from at least
Two former clients indicating the nature/period of jobs done and capability
Equipment & Technical Capacity
Evidence of membership of professional body
Evidence of collaboration/affiliation-partner aggreement between an overseas
based company and its indigenous partner or an evidence of legal arranegements

5.

Declaration:

On behalf of ,
(Company name)

I/We . do hereby affirm that the information


given above is true. I/We have also understood that any false information provided by me/us shall disqualify
me/us for being accredited. All payments made by me/us shall therefore be forfeited and I/we shall not be
eligible to re-apply for accreditation until a period of 6 months has elapsed.

Signature . Date
FOR OFFICIAL USE
Documents cited:
(i)
Certificate of Incorporation
(ii)
Memorandum of Association
(iii)
3 years Current Tax Clearance Certificate
(iv)
Tax Identification Number (TIN)
(v)
Evidence of similar past work done
(vi)
Evidence of Payment of Accreditation Form
(vii)
Any other supporting document(s) attached
Receiving Officer Designation ..
Signature ... Date .......................

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