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Application Form for the Authorisation of Research and Development of a Plant Protection Product

FORM DETAILS

Applications will not be considered valid unless the application form is duly completed and all correct documents and correct labels have been submitted with this form. Payment has to be effected within 3 days from the submission of this form for the application to be considered valid. It is recommended that proof of payment of the applicable fees is submitted via the upload section available hereunder, otherwise the application will not be processed until payment is performed.

APPLICANT DETAILS

Are you a returning user?

A 'returning user' is one who has at least filled in this form once, from the 22nd of July 2020 onwards. If any personal or company details have changed from when you last submitted this form, the you are kindly asked to click 'No'. By clicking 'Yes', you are declaring that you have already provided your personal details in this form, and will therefore be asked for the email address only.

If you are unsure whether you are a returning user or not, you may either click 'No' or else contact the MCCAA for assistance.

Full name

Address

Email address

Please check the format of your answer.

Please ensure that the email address is correct as it will be used for acknowledgement purposes and also to get in touch with you.

Contact no.

Only numbers may be entered in this field.

Contact person

DETAILS OF PERSON RESPONSIBLE FOR R&D IN MALTA

Full name

Address

Email address

Please check the format of your answer.

Contact no.

Only numbers may be entered in this field.

Contact person

DETAILS ON PLANT PROTECTION PRODUCT

Trade name / proposed trade name

Type of plant protection product

Check all that apply

Fungicide
Molluscicide
Insecticide
Repellent
Herbicide
Rodenticide
Plant growth regulator
Bactericide

ACTIVE INGREDIENT 1

Content & tolerance limits of active inrgedient in %(w/w, g/l) in the technical product

	Active ingredient	CAS number	Content	Tolerance limit % (w/w, g/l)
1	Active ingredient	CAS number	Content	Tolerance limit % (w/w, g/l)

Is the ownership of data on the active ingredient different from the applicant details?

If 'yes' please fill in the details of the owner who gave you the letter of access

Company name
Address
Email address
Contact no.
Contact person

If 'no' please specify why

Choose one of the following answers

Applicant and ownership details of data are identical
Active ingredient is not approved yet

ACTIVE INGREDIENT 2

Content & tolerance limits of active ingredient in % (w/w, g/l) in the technical product

	Active ingredient	CAS number	Content	Tolerance limit % (w/w, g/l)
2	Active ingredient	CAS number	Content	Tolerance limit % (w/w, g/l)

Is the ownership of data on the active ingredient different from the applicant details?

If 'yes' please fill in the details of the owner who gave you the letter of access

Company name
Address
Email address
Contact no.
Contact person

If 'no' please specify why

Choose one of the following answers

Applicant and ownership of data are identical
Active ingredient is not approved yet

ACTIVE INGREDIENT 3

Content & tolerance limits of active ingredient in % (w/w, g/l) in the technical product

	Active ingredient	CAS number	Content	Tolerance limit % (w/w, g/l)
3	Active ingredient	CAS number	Content	Tolerance limit % (w/w, g/l)

Is the ownership of data on the active ingredient different from the applicant details?

If 'yes' please fill in the details of the owner who gave you the letter of access

Company name
Address
Email address
Contact no.
Contact person

If 'no' please specify why

Choose one of the following answers

Applicant and ownership of data are identical
Active ingredient is not approved yet

RELEASE OF PRODUCT

Maximum quantities to be used or released during the research

Undiluted quantity
Diluted quantity (if applicable)

PRODUCT AUTHORISATION

Is the product already authorised for research and development in another EU country?

If 'yes' please list the EU Member States where the product is authorised

Please fill in at least one answer

	Member State	Registration number	Date	Product name	Expiry date
1	Member State	Registration number	Date	Product name	Expiry date
2	Member State	Registration number	Date	Product name	Expiry date

RESEARCH

Trail will be held in

Choose one of the following answers

Glasshouse
Open-field

Trial details

Identification number of parcel where trail will be held
Town where trail will be held
Crop on which product will be applied
Pest/disease treated
Area under trail
Equipment to be used
Method of application

REQUESTED DOCUMENTATION

Please ensure that all documentation below is attached to this form:

Letter of access of each active ingredient (in the event that the ownership of data of each active ingredient is different than the applicant data);
Document confirming authorisation of the research and development in other EU countries (in the case that such product is authorised in other EU countries);
Dossier or letter of access to the dossier which includes information regarding the chemical, physical and biological properties of the plant protection product as determined by scientifically acceptable and validated laboratory, and data with any possible effects on human or animal health or the possible impact on the environment;
Contingency plan in case of any contamination, release or spread of plant protection product;
SDS for the forumlant in accordance with Regulation 1272/2008/EC;
Product label.

Kindly attach any relevant documents (you may opt to compress all files into .a rar file not larger than 10MB)

Please upload at most 10 files

Upload files

Use this option to:

- attach any relevant supporting information as noted in the questions above.
- upload proof of payment.

PAYMENT DETAILS

Payment of € to be effected within 3 days from submission of application

Payment method

Choose one of the following answers

Bank transfer
Cheque (payable to MCCAA)

Bank Account Details

Bank name: Bank of Valletta

IBAN number: MT14VALL22013000000040019986609

Swift code: VALLMTMT

DECLARATIONS

Content Declaration

Check all that apply

I, hereby declare that the details furnished in this application are true and correct to the best of my knowledge and belief and I undertake to inform the Malta Competition and Consumer Affairs Authority of any changes therein, immediately. In case any of the above information is found to be false, untrue, misleading or misrepresenting, I am aware that I may be held liable for it.

Data Protection Declaration

Check all that apply

The Malta Competition and Consumer Affairs Authority ("the Controller") will process your personal data in accordance with the relevant provisions of the General Data Protection Regulation (GDPR), the Data Protection Act (Chapter 586 of the Laws of Malta) and other regulations made thereunder. The Controller will process your personal data for licensing and administrative purposes and to comply with its legal obligations. For further information on how your personal data will be processed refer to the Controllers's privacy policy.
I, the data subject, hereby consent to having the Malta Competition and Consumer Affairs Authority collect and process my personal information from this application.

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