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Eclaration I confirm that I have not provided any information on this form or in the associated documentation which I know to be false or do not believe to be true. Signed applicant agent Date Date APPLICANT MUST SIGN ABOVE Please Note: Should the Department discover that any false or misleading information has been provided, any consent issued shall be invalid. The applicant may also be liable to prosecution. On completion this form should be returned to; Northern Ireland Environment Agency,.

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