MDPPACPB Regulations

Page 121 of 127
121 
 
1. Name of Licensee/Operator: 
[Insert full legal name of company] 
2. Corporate Registration Number: 
[Insert RC number or business registration identifier] 
3. Address of Principal Office: 
[Insert office address, email, phone number] 
4. Designated Compliance Officer: 
o 
Name: 
o 
Title: 
o 
Email and Phone: 
o 
Date of Appointment: 
5. Reporting Period: 
[Insert calendar year (e.g., January 1 – December 31, 2025)] 
6. Business Segments Operated (Tick all applicable): 
☐ Natural Gas Processing 
☐ Gas Transportation 
☐ Gas Distribution 
☐ Petroleum Products Storage 
☐ Pipeline Transportation 
☐ Wholesale Marketing 
☐ Retail Sales 
☐ Import/Export 
☐ Others (specify): 
7. Licences Held (as at year-end): 
o 
Type of Licence(s): 
o 
Licence Number(s): 
o 
Issuing Date(s): 
8. Changes in Corporate Structure (if any during the year): 
☐ Merger 
☐ Acquisition 
☐ Divestiture 
☐ Entry/Exit of Business Segment 
☐ Others (describe): 
Provide description and effective dates: 
 
PART B: INTERNAL COMPLIANCE SYSTEMS 
9. Summary of Internal Compliance Measures Taken During the Reporting Year: