石油煉製業經營許可申請書

Oil Refinery Business Operation License Application Form

單位：公秉（液化石油氣為公噸）

Unit: KL (tonne for LPG)

營業主體 Business Entity	公司名稱 Business Name
所在地 Business Address
實收資本額 Paid-in Capital	營利事業統一編號 Uniform Business Number
負責人 Representative	身分證統一編號 National ID Number of Representative
營運狀況 Operating Condition	工廠廠址 Factory Address
建廠日期 Construction Start Date	完工日期 Completion Date
設備項目 Facilities	設置進度 Construction Progress
主要產品 Primary Product	年產能量 Annual Production Capacity
附件 Supporting Documents	負責人身分證明文件 Representative identification □規費繳交證明 Proof of fees paid 公司設立證明文件 Corporation registration document 工廠登記證明文件 Factory registration document 石油煉製業設立許可同意函 Oil Refinery Business Establishment Permit 符合石油管理法第24條所定安全存量以上之儲槽容量證明文件Documents verifying that the oil storage facility has the capacity to comply with the security stockpile requirement as specified in Article 24 of the Petroleum Administration Act 儲油設備基本資料表 Basic information for the oil storage facility 儲油設備租約證明（屬租用者） Oil storage facility lease (if the facility is rented) 儲油設備相關文件 Documents related to the oil storage facility： 當地縣（市）政府建設局核發之雜項及使用執照 Miscellaneous licenses and usage licenses issued by the local competent authorities of the place of establishment 儲槽容量證明文件 Documents verifying the capacity of the oil storage facility 屬液化石油氣者，須具有勞檢單位檢查合格之高壓氣體檢查合格證明，並載明液化石油氣儲槽種類。 For LPG, the inspection certificate(s) of LPG tanks from the labor inspection office, specifying the type of tank 安全存量之儲油設備屬自由港區事業之倉庫（自貿槽）或保稅倉庫（保稅槽）者，應變更為一般倉儲（非屬自貿、保稅槽），並檢附相關證明文件。 Where security stockpile storage facility is a warehouse of a free trade zone business (free trade tanks) or a bonded warehouse (bonded tanks), it shall be converted into an ordinary warehouse (non-free trade or bonded tanks), and shall submit relevant certificate(s).

公司印章Company's seal：

負責人簽章Signature & Seal of the Representative：