Signature of the Occupier or
Operator of the disposal facility
Date..............
Place.............
Form 5
[See rules 13 (1) and 14 (1)]
Application for Import or Export of Hazardous and other Waste for reuse or Recycling or Recovery or Co-Processing or Utilisation
To be Filled in by Applicant
S. No.
Description
Details to be furnished by the importer or
exporter
(1)
(2)
(3)
1.
Importer or Exporter (name and address) in India
Contact person
Tel, fax and e-mail
Facility location/address
Reason for import or export
2.
Importer or exporter (name and address) outside of India
3.
Details of waste to be imported or exported
(a)
Quantity
(b)
Basel No.
(c)
Single/multiple movement
(d)
Chemical composition of waste (attach details), where
applicable
(e)
Physical characteristics
(f)
Special handling requirements, if applicable
4.
For Schedule III A hazardous waste whether Prior Informed
Consent has been obtained
5.
For importer
(a)
Process details along with environmental safeguard measures
(attach separate sheet)
(b)
Capacity of recycling or co-processing or recovery or
utilization
Enclose a copy each of valid authorisation and valid
consent to operate from SPCB
6.
Details of import against the Ministry of Environment, Forest
and Climate Change permission in the previous three years
7.
Port of entry