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Golder Associates
PROPOSED SOUTH WESTERN KAROO BASIN GAS Public Participation Office
EXPLORATION PROJECT
Toni Pietersen/Nomthi Mnisi
REGISTRATION AND COMMENT SHEET PO Box 6002, Halfway House, 1685
Tel (011) 254-4805/313-1072 Fax (011)
Accompanying Background Information Document,
315-0317
January 2011 Email karoo@golder.co.za
Please complete by Friday, 18 February 2011, and return to the Public Participation Office (as above)

TITLE FIRST NAME If you are an affected

INITIALS SURNAME landowner, please tell
us your farm name
ORGANISATION EMAIL and erf / portion
number
POSTAL ADDRESS _________________
POSTAL CODE
TEL NO FAX NO _________________

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 the
exploration licence application project (including the Western, Central and Eastern
YES NO
Precincts) so that I may receive further information and notifications during the EMP
process
Western Precinct YES NO
I would only like to receive information about the (mark the applicable exploration licence YES NO
Eastern Precinct
application project you are interested in):
Central Precinct YES NO
Letter (mail) YES NO
Email YES NO
I would like my notifications by
Fax YES NO
Telephone YES NO
Paper copies YES NO
I would like to receive documents for comment as follows By email YES NO
On CD YES NO
English YES NO
I would like my summary documents for comment in Afrikaans YES NO
Xhosa 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 the
approval 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.
Please tell us why:
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

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