Application for Import Permit for Chemicals Used in Explosives Production

<h4 style="text-align: center;">Application for Import Permit for Chemicals Used in Explosives Production</h4>

<p>                       Request for permission to release chemical materials for which an import permit number (             ) was issued on (date) 144 AH and expires on (date)      /        / 144    AH. 
                    </p>

<table dir="ltr">
                        <tr>
                            <td colspan="4" style="text-align: center; background-color: #dfdfdf;">Importer information</td>
                        </tr>
                        <tr>
                            <td>Name of establishment</td>
                            <td colspan="3" style="width: 90%"></td>
                        </tr>
                        <tr>
                            <td>Commercial registration number </td>
                            <td colspan="1" style="width: 40%"></td>
                            <td>Registration date </td>
                            <td colspan="1" style="width: 40%"></td>
                        </tr>
                        <tr>
                            <td>City</td>
                            <td colspan="1" style="width: 40%"></td>
                            <td>Email address </td>
                            <td colspan="1" style="width: 40%"></td>
                        </tr>
                        <tr>
                            <td>Address</td>
                            <td colspan="1" style="width: 40%"></td>
                            <td>P.O. Box </td>
                            <td colspan="1" style="width: 40%"></td>
                        </tr>
                        <tr>
                            <td>Mobile</td>
                            <td colspan="1" style="width: 40%"></td>
                            <td>Telephone</td>
                            <td colspan="1" style="width: 40%"></td>
                        </tr>
                    </table>

<table dir="ltr">
                        <tr>
                            <td colspan="12" style="text-align: center; background-color: #dfdfdf;">Chemical materials data</td>
                        </tr>
                        <tr>
                            <td style="width: 5%; text-align: center;" rowspan="2">م</td>
                            <td style="text-align: center; width: 15%;" colspan="2">Scientific name </td>
                            <td rowspan="2" style="width: 10%; text-align: center;">Trade name </td>
                            <td style="text-align: center; width: 10%;">Customs item number </td>
                            <td style="text-align: center; width: 10%;">Chemical abstract service (CAS) </td>
                            <td rowspan="2" style="text-align: center; width: 10%;" style="text-align: center;">Purchase invoice number</td>
                            <td rowspan="2" style="text-align: center; width: 10%;">Hazard classification </td>
                            <td style="text-align: center; width: 8%;">Quantity remaining in the import permit </td>
                            <td style="width: 8%; text-align: center;">Quantity imported (numerical and written) </td>
                            <td style="text-align: center; width: 7%;" rowspan="2">Customs declaration </td>
                        </tr>
                        <tr>
                            
                            <td style="text-align: center;">Arabic</td>
                            <td style="text-align: center;">English</td>
                            <td style="text-align: center;">Harmonized System (HS) number </td>
                            <td style="text-align: center;">CAS number </td>
                            <td style="text-align: center;">Numeric and written unit (kg/L) </td>
                            <td style="width: 8%; text-align: center;">Unit (kg/L) </td>
                        </tr>
                        <tr>
                            <td style="width: 5%; text-align: center;" rowspan="10">1</td>
                            <td style="text-align: center; width: 10%;" >Arabic</td>
                            <td style="text-align: center; width: 10%;">English</td>
                            <td rowspan="10" style="width: 10%; text-align: center;"></td>
                            <td style="text-align: center; width: 10%;" rowspan="10"></td>
                            <td style="text-align: center; width: 10%;"></td>
                            <td rowspan="10" style="text-align: center; width: 10%;" style="text-align: center;"></td>
                            <td rowspan="10" style="text-align: center; width: 10%; font-size: large; font-weight: bold;">1</td>
                            <td style="text-align: center; width: 8%;" rowspan="6"></td>
                            <td style="width: 8%; text-align: center;" rowspan="6"></td>
                            <td style="text-align: center; width: 7%;" rowspan="10"></td>
                        </tr>
                        <tr>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                        </tr>
                        <tr>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                        </tr>
                        <tr>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                        </tr>
                        <tr>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                        </tr>
                        <tr>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                        </tr>
                        <tr>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;" rowspan="4"></td>
                            <td style="text-align: center;" rowspan="4"></td>
                        </tr>
                        <tr>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                        </tr>
                        <tr>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                        </tr>
                        <tr>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                            <td style="text-align: center;"></td>
                        </tr>
                        <tr>
                            <td style="text-align: center; font-size: medium; font-weight: bold;" colspan="6">Manufacturer </td>
                            <td style="text-align: center; font-size: medium; font-weight: bold;" colspan="6">Source</td>
                        </tr>
                        <tr>
                            <td style="text-align: center; font-size: medium; font-weight: bold;" colspan="6"></td>
                            <td style="text-align: center; font-size: medium; font-weight: bold;" colspan="6"></td>
                        </tr>
                    </table>

<table>
                        <tr>
                            <td colspan="4" style="text-align: center; background-color: #dfdfdf;">Demand estimator data</td>
                        </tr>
                        <tr>
                            <td style="width: 25%; text-align: center;">Name of the manager of the importing entity or the authorized person (in quadruplicate) </td>
                            <td style="width: 30%; text-align: center;"></td>
                            <td style="text-align: center;">Stamp</td>
                        </tr>
                        <tr>
                            <td style="width: 25%; text-align: center;">ID number </td>
                            <td style="width: 30%; text-align: center;"></td>
                            <td rowspan="4"></td>
                        </tr>
                        <tr>
                            <td style="width: 25%; text-align: center;">Mobile number</td>
                            <td style="width: 30%; text-align: center;"></td>
                        </tr>
                        <tr>
                            <td style="width: 25%; text-align: center;">Email Address</td>
                            <td style="width: 30%; text-align: center;"></td>
                        </tr>
                        <tr>
                            <td style="width: 25%; text-align: center;">Certified signature and date </td>
                            <td style="width: 30%; text-align: center;"></td>
                        </tr>
                    </table>

<p dir="rtl" style="text-align: right;">
                        <h4>The name of the relevant authority:</h4>
                    </p>
                <div dir="ltr">
                    <div style="display: flex; justify-content: space-between;">
                        <div style="display: flex; align-items: center; margin-bottom: 10px; justify-content: end; gap: 15px;">
                            <div style="display: flex; align-items: center; gap: 10px;">
                                <span>Rejected stamp (reason)</span>
                                <span style="font-size: x-large; line-height: 0%;">□ </span>
                            </div>
                            <div style="display: flex; align-items: center; gap: 10px;">
                                <span>Approved </span>
                                <span style="font-size: x-large; line-height: 0%;">□ </span>
                            </div>
                        </div>
                        <div style="width: 30%; font-weight: bold;">
                            Stamp
                        </div>
                    </div>
                    <p dir="ltr" style="text-align: left;">
                        Name of the official: 
                    </p>
                    <p dir="ltr" style="text-align: left;">
                        Functional center: 
                    </p>
                    <p dir="ltr" style="text-align: left;">
                        Authorized signature and date: 
                    </p>
                    <hr style="margin: 0; padding: 0;">
                    <p>
                        <h4>The Higher Industrial Security Committee (Central Security Licensing Unit) </h4>
                        <div style="display: flex; justify-content: space-between;">

<div style="display: flex; align-items: center; margin-bottom: 10px; justify-content: end; gap: 15px;">
                                <div style="display: flex; align-items: center; gap: 10px;">
                                    <span>Rejected stamp (reason)</span>
                                    <span style="font-size: x-large; line-height: 0%;">□ </span>
                                </div>
                                <div style="display: flex; align-items: center; gap: 10px;">
                                    <span>Approved </span>
                                    <span style="font-size: x-large; line-height: 0%;">□ </span>
                                </div>
                            </div>
                            <div style="width: 30%; font-weight: bold;">
                                Stamp
                            </div>
                        </div>
                        <p dir="ltr" style="text-align: left;">
                            Name of the official:
                        </p>
                        <p dir="ltr" style="text-align: left;">
                            Functional center: 
                        </p>
                        <p dir="ltr" style="text-align: left;">
                            Authorized signature and date: 
                        </p>
                        <hr style="margin: 0; padding: 0;">
                        <small>Important Note: This form is on the imported organization's papers and must be filled in by printing the data. Handwriting is not allowed, and modification, addition, or scraping is prohibited. </small>
                    </p>
                </div>

</div>