MDPPACPB Regulations

Page 92 of 127
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APPLICATION FOR APPROVAL UNDER SECTION 211(2) OF THE ACT 
 
SECTION A: APPLICANT DETAILS 
 
1. 
Name of Applicant(s): ___________________________________ 
 
2. 
Registered Address: _____________________________________ 
 
3. 
Contact Person: _________________________________________ 
 
4. 
Phone Number / Email: ___________________________________ 
 
5. 
Legal Representative (if any): _____________________________ 
 
SECTION B: NATURE OF PROPOSED CONDUCT OR ARRANGEMENT 
6. Description of the conduct/arrangement for which exemption is sought 
(attach supporting documents): 
    _________________________________________________________________________ 
7. Parties involved: ________________________________________ 
8. Type of conduct (tick as applicable): 
☐ Joint venture ☐ Infrastructure sharing ☐ Supply coordination ☐ 
Standardisation agreement 
☐ Emergency supply agreement ☐ Transitional arrangement ☐ Other (specify): 
___________ 
 
SECTION C: MARKET AND PUBLIC INTEREST JUSTIFICATION 
9. Relevant product and geographic markets affected: 
    _________________________________________________________________________ 
10. Description of impact on market structure, price, innovation, output or 
access: 
    _________________________________________________________________________ 
11. Justification for exemption in the public interest or for market functionality: 
    _________________________________________________________________________ 
12. Expected consumer benefits: 
    _________________________________________________________________________