Application for Transport Service Permit - De Doorns, Rawsonville ...

FIRE SAFETY INSPECTORATE
Tel: 023 348 9064 Fax: 023 347 1653 Email: firesafety@bvm.gov.za
EMERGENCY: 023 342 2430
APPLICATION FOR TRANSPORT PERMIT:
CONVEYANCE OF DANGEROUS GOODS
DETAILS OF OPERATOR
Name of Operator
Trading as:
Street Address
Suburb City/Town Code
Office Telephone
Fax
Alt. Contact no.
Email
Transport Route/s
(tick more than one if
applicable)
Type or class of vehicle
Registration No.
Make
Number of tanks
Quantity of
substance to be
conveyed
LOCAL REGIONAL PROVINCIAL NATIONAL
FLAMMABLE
LIQUID (l)
DETAILS OF VEHICLE **
FLAMMABLE
GAS (kg)
Year of
manufacture
Capacity of
tanks
**On the day of inspection; the Client must bring along original or certified copies of:
a. The Certification of Roadworthiness of the vehicle, and the
b. Motor Vehicle Licence, Licence Disc and Roadworthy Certificate and Operator Card
FLAMMABLE
SOLID (kg)
It is hereby confirmed that the above information is accurate and by making the application, I understand
that my application is subject to laws and regulations, including the municipal fire safety bylaws and South
African National Standards (SANS) related to the Transportation of Dangerous Goods.
………………………..
Date
………………………………………
Signature of Applicant
FOR FEES SCHEDULE AND PAYMENT INSTRUCTIONS, PLEASE SEE OVERLEAF.
BVFD FRSM - Form: C-TSP/ DG

Fees Schedule and Instructions for Payment and
1. The Prescribed Application Fee payable INCLUDING VAT is:-
For Light Delivery Vehicles: up to 3 500kg R 260.00
For Rigid Tankers: up to 20 000 litres R 520.00
For Rigid Tankers above 20 000 litres R 780.00
Up to 20 000 litres
For Horse R 206.00
Per Unit thereafter R 520.00
Above 20 000 litres
For Horse R 210.00
Per Unit thereafter R 780.00
+ [ADD] Issuing Fee per Certificate to relevant category listed above R 195.00
2. This Fee must be paid at any of the Municipal Treasury Offices found at the following
locations:
a. De Doorns 4 La Rochelle Street 023 356 2102 /023 356 2105
b. Rawsonville 17 Le Seur Street 023 349 1201
c. Touws River Logan Street 023 358 1192
d. Worcester 53 Baring Street 023 348 4941
3. Should you wish to make payment via Electronic Funds Transfer [EFT] or direct deposit ; please
use the following details:-
a. Account Holder : Breede Valley Municipality
b. Bank : ABSA
c. Branch Code: 503107
d. Account number: 01000010312
e. Unique Reference : 1201704159
4. Proof OF PAYMENT (Notification) must be sent to fireadmin@bvm.gov.za
Please note that EFT’s normally take at least two days to reflect on the Municipal Banking
Account.
5. Once Payment has been made (either manually or electronically); please bring completed
form and proof of payment to the Fire Department (1 Mercer Street, Worcester); or you may
telephonically contact the Fire Safety Inspectorate to make a booking.
6. Inspections will only be scheduled upon receipt of necessary paperwork and proof of
payment. Inspections are usually scheduled within 7 days from date of receipt of application
BVFD FRSM - Form: C-TSP/ DG