ASR1 - Application for a Licence or Renewal of a Licence to Manufacture and/or compress and/or fill cylinders with acetylene gas at equal to or greater than 0.62 bar (g) under the Acetylene Safety (England and Wales and Scotland) Regulations 2014 (The 'regulations')

Please read the guidance notes at the end of this document before completing the application.

Application type and nature of business to be undertaken *What activity is the application for? (Select all that apply)
Manufacture	Compress	Fill cylinders
*What is this licence application for? (Select one)
New Licence	Renewal	Variation	Transfer

*If this is a renewal/variation/transfer application, please state the date of expiry and any reference number
*Licence expiry date	*Reference Number
*Nature of business including relevant activity undertaken

Details of the applicant (If you are applying on behalf of a company or limited liability partnership (or, in Scotland only, a partnership) please give its name)
*Are you a company or an individual?	Company	Individual
*Name of applicant	Companies House No

Where applicant is an individual

Date and place of birth	NI Number

Note: for addresses you must provide Address Line 1 or 2, Town and post code at minimum. If the applicant is a company or partnership, please give the registered address or where there is no registered address, the principal place of business.

*Address Line 1	(eg building name)
Address Line 2	(eg street)
Address Line 3	(eg district)
*Town
County	*Post code

*Daytime Phone Number	Mobile Number	Email Address

Address where the activity will take place
Note: for addresses you must provide Address Line 1 or 2, Town and post code at minimum

*Address Line 1	(eg building name)
Address Line 2	(eg street)
Address Line 3	(eg district)
*Town
County	*Post code

If the applicant is not the owner/manager of the business, please give details of the person with management responsibilities for the relevant activity for which this licence is sought (eg Company Secretary, Director)

Name	Position
Daytime Phone Number	E-mail Address

*Is your address different from the activity address given above?	Yes	No

If yes, please provide the full address, including post code, of the person with the management responsibilities for the relevant activity
(Note: for addresses you must provide Address Line 1 or 2, Town and post code at minimum)

*Address Line 1	(eg building name)
Address Line 2	(eg street)
Address Line 3	(eg district)
*Town
County	*Post code

Out of hours contact details (if different from above) – please give the name, telephone number and/or mobile number if appropriate, of the person to be contacted in an emergency

Name
Phone Number	Mobile Number

Please go to declaration on next page

Declaration

*I agree to the information provided, to the activity undertaken eg the amount of acetylene gas that may be manufactured or stored on the premises, being shared with the emergency services in the event of an incident.

Name	Position / Job title
Organisation (if applicable)
Date

Please indicate the following documents are enclosed:

Application Fee
Supplementary information sheet (if applicable)
Plan of the site
Quantities of cylinders and compressed gas

Guidance to Applicants

IMPORTANT - It is your responsibility to ensure you are aware of, and comply with, the provisions of the regulations. Under regulation 11, the licensing authority has the power to revoke a licence if there has been a change of circumstances leading the licensing authority to conclude that the requirements in regulation 9(2) are no longer satisfied.

This form should only be used for an application for a licence to manufacture and/or compress and/or fill cylinders of certain standards with acetylene gas at equal to or greater than 0.62 bar (g) under the regulations.

If there is insufficient room to provide the information requested, please continue on a separate sheet(s). You should also put your name and (registered) address or principal place of business at the top of each sheet(s) before attaching the sheet(s) to your application form.

Please contact the Health and Safety Executive / the Office for Nuclear Regulation if you have any questions about completing this form or about your application Explosives.Licencing@hse.gov.uk.

Guidance to Applicants

The following documents should be submitted with the application form further to 6(2) of the regulations.

A plan to a scale sufficient to show the location of the premises in relation to its surroundings (i.e. named or numbered roads, hamlets, villages or geographical features). Where the premises do not have a postal address this should normally be a minimum scale of 1:25000

The layout of the acetylene plant buildings such that individual parts of the acetylene plant and the acetylene storage areas are clearly shown on the plan.

The process flow between the components making up the acetylene plant is clearly shown on the plan.

If you have applied minimum separation distances specified in EIGA Doc IGC 123/12/E please include details. If you have applied other separation distances, provide details of separation distances applied and why.

Details of: (i) The maximum amount of acetylene gas you wish to compress at equal to or greater than 0.62 bar(g) on the premises and; (ii) The maximum number of cylinders you want to fill with compressed acetylene gas on the premises.

If you intend to store, process or manufacture compressed acetylene gas within a building that is also used for other hazardous substance(s) you should include a floor plan showing the places within the building where you intend storing, processing or manufacturing the other hazardous substance(s).

Details of an electronically operated fire alarm system and locations of all call points. (As a minimum this should be located at the exits to the filling hall and compressor room).

The details of a manually actuated deluge system for cooling hot cylinders and the location of actuation points.

The fee must also be submitted with the application. Fees are payable on the scale laid down in the current Health and Safety (Fees) Regulations. An original, renewed, varied, transferred or replacement licence cannot be issued until the fee, which will be calculated on completion of work, has been paid. Also a fee is payable for the work done on any application which is withdrawn before completion. Information on fees can be found at www.hse.gov.uk/fireandexplosion/acetylene-licensing.htm or contact Explosives policy team in HSE: Explosives.Licencing@hse.gov.uk for advice.

Supplementary information sheet - If there is insufficient room to provide the information requested, please continue on a separate sheet(s). You should also put your name, and (registered) address or principal place of business at the top of each sheet(s) before attaching the sheet(s) to your application form.

Period of validity

The expiry date of the licence (if any) will be given on the licence document. Should your licence document have no expiry date, the licence shall run indefinitely unless varied, revoked, transferred.

The information gathered on this form may constitute personal data as defined in the Data Protection Act 1998. Any personal data will be processed in accordance with the requirements of that Act.