Southern LNG Inc.

Original Volume No. 1

 Contents / Previous / Next / Main Tariff Index



Effective Date: 12/01/2001, Docket: CP99-582-004, Status: Effective

Original Sheet No. 111 Original Sheet No. 111 : Effective





5. Date service is requested to commence: ______________________________________


Date service is requested to terminate: ________________________________________


To be considered a valid request service must be requested to begin _____ months of the date of the

request, except if the request involves the construction of facilities or the issuance of any necessary

certificate authorization to Southern LNG.


6. Maximum Storage Quantity (MSQ) requested: __________ Mcf.


7. Submit, pursuant to Section 2.1(a) of the General Terms and Conditions of Southern's LNG Tariff, (i)

Customer's DUN & BRADSTREET (DUNS) number; (ii) Customer's most recent audited financial statements,

annual report, Form 10-K; (iii) three credit references; and (iv) a list of affiliates, in order to

enable Southern LNG to evaluate Customer's creditworthiness.


8. On Attachment A hereto, provide the information related to each of Customer's vessel(s) from which

Southern LNG would receive LNG for Customer's account. Customer shall provide, as requested, any

additional information that Southern LNG requires to determine whether Customer's vessel(s) will

interface with Southern LNG's facilities without any modification.


Customer understands that before this request is logged in by Southern LNG, Southern LNG must receive this

request form, complete and unrevised as to format. Customer hereby agrees to pay Southern LNG's currently

effective rates applicable to the Rate Schedule. Customer, by its signature and seal below, represents to

Southern LNG that the information above is correct and accurate.


Customer, by its signature and seal below, certifies (i) that it has entered into or will enter into those

arrangements necessary to assure all upstream and downstream transportation will be in place prior to the

commencement of service under the service agreement requested herein; (ii) that upon the commencement of service

hereunder, but not as a condition precedent thereto, Customer will provide the names of all upstream and

downstream transporters involved in the transportation of gas hereunder; (iii) that Customer has title or a

current contractual right to acquire title to the gas to be delivered to Southern LNG; and (iv) that Customer

has all necessary permission, licenses, and certificates from all government agencies having jurisdiction over

its delivery of gas to, and receipt of gas from, Southern LNG.


Very truly yours,




By _____________________________________

Its _____________________________________




Date ___________________________________