Forms
The following forms require either Microsoft Word or Acrobat Reader. You may download
these programs by clicking on http://www.gov.mb.ca/example/utilities.html.
Please use Microsoft Word to complete and submit your forms. The forms with the
* may be
submitted as an attachment to petropub@gov.mb.ca.
Then, click on the file name to open the document. You may then view, print, complete and
submit them by mail or fax to:
Science, Technology, Energy and
Mines
Petroleum Branch
Box 1359
227 King Street West
Virden MB R0M 2C0
Phone: 204-748-4260
or Fax: 204-748-2208
Microsoft Word
Acrobat Reader
Application and Registration Forms
|
Application To: (Abandon, Deepen, Suspend, etc.) |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Application for a Flow Line License
|
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Equipment Registration |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Well License |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Consent of Occupant
|
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Transfer
of Well License |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
New Well Summary - Vertical Well
New |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
New Well Summary - Horizontal Well
New |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Rehabilitation and Certificate of Abandonment
Forms
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Acknowledgement of Restoration
Abandonment, Restoration and Rehabilitation Procedures![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif)
Abandonment, Restoration and Rehabilitation Procedures
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif)
|
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Application for Certificate of Abandonment |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Company Rehab. Submission Form |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Geophysical Forms
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Application for Geophysical License |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Report on Flowing
Shot Hole
New |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Report on Unexploded Charges
New |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Production, Crown Royalty and
Freehold Tax Forms
|
Monthly Oil and Gas Production Report and Crown Royalty Statement |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Non-Unit Sample |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Unit Sample |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Monthly Freehold Oil and Gas Production Tax |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Non-Unit Sample |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Unit Sample |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
*Initial Injection / Disposal Report |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
*Initial Production Report |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Crown Oil and Gas Land
Administration Forms
|
Transfer of Disposition |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Transfer of an Undivided Interest in a Disposition |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Transfer of Part of Lease Area |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Notice of Instrument |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
Discharge of Instrument |
![Microsoft Word](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/ms-icon.gif) |
![Adobe Acrobat Reader](/web/20061121033705im_/http://www.gov.mb.ca/iedm/petroleum/p-images/format-pdf.gif) |
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