8/7/2019 Golder Registration & Comment Sheet

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PROPOSED SOUTH WESTERN KAROO BASIN GASEXPLORATION PROJECT

REGISTRATION AND COMM ENT SHEETAccompanying Background Informa tion Document,

January 2011

Golder AssociatesPublic Participation Office

Toni Pietersen/Nomthi MnisiPO Box 6002, Halfway House, 1685

Tel (011) 254-4805/313-1072 Fax (011)315-0317

Email karoo@golder.co.za

Please complete by Friday, 18 February 2011, and return to the Public Participation Office (as above)

REGISTRATION AS INTERESTED OR AFFECTED PARTY (I&AP) (please circle applicable box)

Please formally register me as an interested and affected party (I&AP) on theexploration licence application project (including the Western, Central and EasternPrecincts) so that I may receive further information and notifications during the EMPprocess

YES NO

I would only like to receive information about the (mark the applicable exploration licenceapplication project you are interested in):

Western Precinct YES NO

Eastern PrecinctYES NO

Central Precinct YES NO

I would like my notifications by

Letter (mail) YES NO

Email YES NO

Fax YES NO

Telephone YES NO

I would like to receive documents for comment as follows

Paper copies YES NO

By email YES NO

On CD YES NO

I would like my summary documents for comment in

English YES NO

Afrikaans YES NOXhosa YES NO

Please indicate (by writing) in the next column which Open House you will attend:

In terms of GNR 543 (EIA process regulations) I disclose below any direct business, financial, personal or other interest that I may have in theapproval or refusal of the application:

.

COMMENTS(please use separate sheets if you wish)

I suggest that the following issues of concern be investigated in the EMP:.

..

I suggest the following for the EMP process and / or the public consultation process:...

Any other comments:..

Please tell us: Was this Background Information Document useful? Please indicate below.

YES, IT WAS USEFUL

NEEDS IMPROVEMENT

NO, IT WAS NOT USEFUL

Please ask the following of my colleagues/friends to register as I&APs for this EMP:.

THANK YOU FOR YOUR CONTRIBUTION

TITLE FIRST NAME

INITIALS SURNAME

ORGANISATION EMAIL

POSTAL ADDRESSPOSTAL CODE

TEL NO FAX NO

Please tell us why:.........................................................................................................................

.........................................................................................................................

If you are an affectedlandowner, please tell

us your farm nameand erf / portion

number

_________________

_________________

mailto:karoo@golder.co.zamailto:karoo@golder.co.za