\nApplication For An Extension Licence To Carry Out An Activity<\/legend>\r\n\r\n

\n\n\n\n\n\n

Form 2 <\/p>\n

Application For An Extension Licence To Carry Out An Activity
\nDescribed By Section 192D of the Public Health Act\n<\/p><\/div>\n

\r\n 1- Name\r\n *<\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n 2- Business Address\r\n *<\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n 3- Registered Address (if different)\r\n <\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

4- Can you please give details of your telephone number, fax number or email code.<\/div>\n

\r\n Telephone Number\r\n *<\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\r\n Fax Number (if any)\r\n <\/span>\r\n <\/label>\r\n \r\n \r\n \r\n<\/div>\n

\n Email Address\n *<\/span>\n <\/label>\n \n \n \n<\/div>\n

\r\n 5- When did you last apply for a licence to carry out an activity prescribed by section 192D of the Public Health Act ? (Please state your last licence\u2019s Serial Number)\r\n *<\/span>\r\n <\/label>\r\n

<\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_139_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_th5dy\" class=\"frm_primary_label\">6- Has your organisation been fined, judicially or administratively reprimanded  or  otherwise  suffered  any  sanction  resulting  from  any  failure  to  uphold  its  legal or contractual duties?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[139]\" id=\"field_th5dy\" rows=\"5\"  data-reqmsg=\"6- Has your organisation been fined, judicially or administratively reprimanded  or  otherwise  suffered  any  sanction  resulting  from  any  failure  to  uphold  its  legal or contractual duties? cannot be blank.\" aria-required=\"true\" data-invmsg=\"6- Has your organisation been fined, judicially or administratively reprimanded  or  otherwise  suffered  any  sanction  resulting  from  any  failure  to  uphold  its  legal or contractual duties? is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_140_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_8qf4h\" class=\"frm_primary_label\">7- Why do you wish to apply for an extension of your licence?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[140]\" id=\"field_8qf4h\" rows=\"5\"  data-reqmsg=\"7- Why do you wish to apply for an extension of your licence? cannot be blank.\" aria-required=\"true\" data-invmsg=\"7- Why do you wish to apply for an extension of your licence? is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_141_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_hlw4l\" class=\"frm_primary_label\">8- Have any of your replies contained in your last application materially changed  in the interim?  Please give full details.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[141]\" id=\"field_hlw4l\" rows=\"5\"  data-invmsg=\"8- Have any of your replies contained in your last application materially changed  in the interim?  Please give full details. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_142_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_smzpx\" class=\"frm_primary_label\">9- What period do you  wish to have your licence extended for:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[142]\" id=\"field_smzpx\" rows=\"5\"  data-reqmsg=\"9- What period do you  wish to have your licence extended for: cannot be blank.\" aria-required=\"true\" data-invmsg=\"9- What period do you  wish to have your licence extended for: is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_144_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_ascir\" class=\"frm_primary_label\">Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ascir\" name=\"item_meta[144]\" value=\"\"  maxlength=\"10\" placeholder=\"DD\/MM\/YYYY\" data-reqmsg=\"Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_450_container\" class=\"frm_form_field  frm_html_container form-field\">Applicant will be required to sign application form prior to document being issued by the Agency.<\/div>\n<div id=\"frm_field_143_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">I  certify  that  the  information  contained  in  this  Application  is  true  to  the  best  of  my  knowledge and belief.\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_143-0\">\t\t\t<label  for=\"field_dawdb-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[143][]\" id=\"field_dawdb-0\" value=\"Yes\"  data-reqmsg=\"I  certify  that  the  information  contained  in  this  Application  is  true  to  the  best  of  my  knowledge and belief. cannot be blank.\" data-invmsg=\"I  certify  that  the  information  contained  in  this  Application  is  true  to  the  best  of  my  knowledge and belief. is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> Yes<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_540_container\" class=\"frm_form_field  frm_html_container form-field\">* obligatory fields<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit\" type=\"submit\"  >Submit<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":11,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2566","page","type-page","status-publish","hentry"],"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"Chris Segovia","author_link":"https:\/\/www.environmental-agency.gi\/author\/csegovia\/"},"rttpg_comment":0,"rttpg_category":null,"rttpg_excerpt":null,"_links":{"self":[{"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/pages\/2566","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/comments?post=2566"}],"version-history":[{"count":2,"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/pages\/2566\/revisions"}],"predecessor-version":[{"id":2636,"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/pages\/2566\/revisions\/2636"}],"wp:attachment":[{"href":"https:\/\/www.environmental-agency.gi\/wp-json\/wp\/v2\/media?parent=2566"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}