Instructions for Form Completion

This document is a Microsoft Word Form

All parts of this form are locked except for those areas (fields) available for data entry.

Open this form as a “copy” in order to preserve the original for future use.

Place your curser at the beginning of the field you wish to complete.

Type in the relevant information. All fields are large enough to accommodate the data required. Fields on the form where large amounts of information are to be entered are self-expanding. If you find there is not enough room in a field to put in the information, check that the information you are entering is in the correct format.

Note that some fields have a drop down list to assist in data entry and clarity as to the type of information required. For these fields, click on the appropriate value from the drop down list to enter the value on the form.

Once you have completed all required fields on the form, print three (3) copies then have each copy signed and dated in blue ink by a responsible officer of the company.

The printed copies of the forms, along with the appropriate supporting technical documentation, are to be submitted to:

Chief Conservation Officer

National Energy Board

444 Seventh Avenue SW

Calgary, AB T2P 0X8

The National Energy Board is implementing a process for submission of electronic application documents. However, until further notice, all application forms and supporting documentation must continue to be supplied as paper documents along with an electronic version on DVD (.pdf preferred).

AUTHORITY TO CONDUCT AN

ENVIRONMENTAL STUDY
Applicant’s Legal Name
NEB Operating Licence No.	Interest Identifier
Land Use Permit No.	Issued by:
Water Licence No.	Issued by:
Region
Geophysical Area
Grids of NTS Map Sheets
Description and Purpose of Operation

(include map if applicable)
SPECIFICS OF OPERATION
Proposed Commencement Date	Proposed Completion Date
Number of Personnel	Number of crews
Estimated Kilometres	km
Equipment/ Vessel / Aircraft / Registration Numbers:
OPERATIONAL CONTACT
Name	E-Mail
Address
Telephone	( ) Ext	Facsimile	( )
ESTIMATED EXPENDITURES
Total	$
What portion of the funding is covered by the Environmental Studies Revolving Funds?	$
CONTRACTORS
Contractor Role	Contractor Name
OTHER INFORMATION
“I certify that I have complied with notification, permitting and / or licencing requirements of all federal / territorial legislation that are applicable to this operation”.
Signed

Date

Responsible Officer of Company	Operator
Name	Telephone	( ) Ext
Job Title	E-Mail
NEB USE ONLY
This operation is authorized under Section 5.(1)(b) of the Canada Oil and Gas Operations Act (O-7) and is subject to the terms and conditions attached to this authorization
Signed

Operation Identifier
Chief Conservation Officer
Date

Authority to Conduct an Environmental Study

Authority to Conduct an Environmental Study

Authority to Conduct an Environmental Study

National Energy Board - NEB

2009-04-09

ardeeliz

National Energy Board - NEB