Schedule 1 Forms

Schedule 1 Forms

section 3(2)

Form 1 Statement of intention regarding easements

section 6(2)(c)

(Pipelines Act 1967)

Pursuant to the Pipelines Act 1967, it is intended to acquire—

1 Easement

2 Easement

Form 2 Instrument to accompany plan

section 6(3)

(Pipelines Act 1967)

Plan No [number] (This is Sheet [sheet number] of a [number] Sheet Instrument)

Plan of pipeline from [place] to [place] containing [number] plan sheets as certified on [date]

| Part 1 | | Full name and address of applicant for licence or variation of licence in whose favour all lands and easements over lands have been acquired or are intended to be acquired | |

| Part 2 | | Details of lands or easements over lands acquired or intended to be acquired | See schedule to this part |

| Schedule | | Land or easement (related to relevant Sheet No of within-mentioned plan) | Reference to title and land description (including County and Parish) | Name of owner | *Details(Registered No or description of any instrument referred to in the Pipelines Regulation 2023, Schedule 2, section 6(d)) | | 1 | | | | | 2 | | | | | 3 | | | | | Etc | | | |

| Part 3 | | Identities of easements referred to in abovementioned plan | (Grouped by categories as prescribed by the Pipelines Regulation 2023, Schedule 2, section 7) | | 1 | | | 2 | | | 3 | | | Etc | |

| Part 4 | | Terms of easements referred to in Part 3 | (Set out the text of each easement as prescribed by the Pipelines Regulation 2023, Schedule 2, section 8) | | 1 | | | 2 | | | 3 | | | Etc | |

| Part 5 | | Details of lands to be excluded or easements to be extinguished | (See schedule to this part) |

| Schedule | | Land or easement (related to relevant Sheet No of within-mentioned plan) | Reference to title and land description (including County and Parish) | Name of owner of subject lands | *Details(Registered No or description of any instrument referred to in the Pipelines Regulation 2023, Schedule 2, section 9(d)) | | 1 | | | | | 2 | | | | | 3 | | | | | Etc | | | |

[Signature of applicant]

* If land is to be vested in the applicant under the , section 21, insert “To be acquired under Pipelines Act”. If lands or easements are to be acquired by other means, specify the other means.