BORANG PERMOHONAN UNTUK MENGIMPORT

SISA PLASTIK KE DALAM MALAYSIA

APPLICATION FORM FOR THE IMPORTATION OF
PLASTIC WASTE INTO MALAYSIA

SILA HANTAR KEPADA:

Please Submit to:

Jabatan Alam Sekitar

Kementerian Alam Sekitar dan Air

Aras 1-4 Podium 2 & 3 Wisma Sumber Asli

No 25 Persiaran Perdana Presint 4

62574 PUTRAJAYA

Talian Umum: 03-8871 2000 / 8871 2200

Faks: 03-8889 1973 / 8888 6120

JAS Line: 1-800-88-2727

www.doe.gov.my
 APPLICATION FOR WRITTEN PERMISSION FOR THE IMPORTATION OF PLASTIC WASTES UNDER BASEL
CONVENTION

A. CONSIGNOR/EXPORTER DETAILS F. IMPORT DETAILS

1. ROB/ROC No: (Optional) 1. Mode of Transport (Maritime/Rail/Road/Air/Post):

2. Company Name & Address: 2. Purpose (Private/Business/Research/Exhibition/Others):

3. State of Export

Country of Origin:
Port of Origin:
3. Contact Person:
Consigned from:
4. Tel No.:

5. Email: 4. State of Import (Malaysia)

B. WASTE GENERATOR DETAILS Place of Import:

1. ROB/ROC No: (Optional) Port of Entry:
Customs Station:
2. Company Name & Address:
5. State of Transit

Port of Transit:

3. Type of Industry: G. PLASTIC WASTE DETAILS

1. Malaysian Customs Tariff (all digit HS Code):
4. Contact Person:

5. Tel No.:
If HS 3915:
6. Email: National Solid Waste Management Department Approval
Approval to Import ☐ Yes ☐ No
C. CONSIGNEE / IMPORTER DETAILS
1. ROB/ROC No: (Optional)
Approved Exporter ☐ Yes ☐ No
2. Company Name & Address:
2. Basel Convention (please tick):

Annex II: Y48 ☐

Annex VIII: A3210 ☐
3. Contact Person:
Annex IX: B3011 ☐

4. Tel No.: 3. Item Description:

5. Email:

D. APPLICANT DETAILS FOR OFFICIAL USE

1. Applicant Name: Consent No.:

2. Applicant I.C./Passport No: Date of Expiry:

3. Applicant Designation:

E. CONFIRMATION OF DETAILS
I certify that the information provided above is true.
___________________________
Date: Signature of Applicant: (Signature & Official Stamp)
Name:

____________________ For the Director-General of Environment Malaysia

 CHECKLIST FOR THE IMPORT APPLICATION

Subject Yes ( √ ) Remarks

1. Cover letter for the Application

2. Application Form

3. Company Profile of the Waste Generator and Importer

4. Certified Copy of I.C. or Passport of the Applicant

5. Copy of the operating license of the importer

6. Contractual Agreement: Waste Generator + Importer/End-User

7. Photos of waste to be imported

8. Information on the waste:

a. source of waste
b. lab analysis
c. % contaminants
d. stock inventory (for the last 3 years)
e. total quantity of waste imported, quantity of each import &
number of shipments
f. history of quantity of waste that has been imported for the
last 3 years, last year & last month

9. Justification for import

10. Technical information on the waste recovery/reuse/recycle

process.

11. Complete process/flowchart of item 10

12. Percentage on residue generated from the above process (item

11) and its further disposal

13. Product from the recovery facility (resin/flakes)

14. Notification form from the Competent Authority of the exporting

country

15. Proforma Invoice: Waste Generator and Importer/End-User

16. Certificate of liability insurance of the notifier and importer/

Bank Guarantee

17. Preloading inspection report with declaration on type of plastic,

% of recycling rate, % contaminants, types of contaminants
from Board of Inspection (authorized by Competent Authority of
exporting country or accredited by the government of exporting
country)

18. Copy of Approval to Import by NSWMD.

Note: The entire documents above are compulsory to be submitted to DOE HQ for processing application.