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Application Form for the Authorisation of a Plant Protection Product as a CMS

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.

GENERAL INFORMATION

Trade name / Proposed trade name

Zonal Rapporteur Member State

APPLICANT DETAILS (PERMANENT COMMUNITY ADDRESS)

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.

Telephone no.

Only numbers may be entered in this field.

Mobile no.

Only numbers may be entered in this field.

Contact person

DETAILS OF REPRESENTATIVE IN MALTA (IF APPLICABLE)

Full name

Address

Email address

Please check the format of your answer.

Telephone no.

Only numbers may be entered in this field.

Mobile no.

Only numbers may be entered in this field.

Contact person

ACTIVE INGREDIENT 1

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

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

Active ingredient classification

	Hazard pictogram code and signal word (Click here to view pictograms)	Hazard statement (H-Numbers)	Precautionary statement (P-Numbers)
1	Hazard pictogram code and signal word (Click here to view pictograms)	Hazard statement (H-Numbers)	Precautionary statement (P-Numbers)

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

Choose one of the following answers

Yes
No, because the applicant and ownership of data are identical

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

ACTIVE INGREDIENT 2

Content & tolerance limitsof active ingredient in % [w/w, g/l] in the technical product

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

Active ingredient classification

	Hazard pictogram code and signal word (Click here to view pictograms)	Hazard statement (H-Numbers)	Precautionary statement (P-Numbers)
2	Hazard pictogram code and signal word (Click here to view pictograms)	Hazard statement (H-Numbers)	Precautionary statement (P-Numbers)

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

Choose one of the following answers

Yes
No, because the applicant and ownership of data are identical
No answer

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

ACTIVE INGREDIENT 3

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

	Active ingredient	CAS number	Content (% technical)	Content (% pure)	Tolerance limit % (w/w. g/l)
3	Active ingredient	CAS number	Content (% technical)	Content (% pure)	Tolerance limit % (w/w. g/l)

Active ingredient classification

	Hazard pictogram code and signal word (Click here to view pictograms)	Hazard statement (H-Numbers)	Precautionary statement (P-Numbers)
3	Hazard pictogram code and signal word (Click here to view pictograms)	Hazard statement (H-Numbers)	Precautionary statement (P-Numbers)

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

Choose one of the following answers

Yes
No, because the applicant and ownership of data are identical
No answer

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

PACKAGING

Retail packaging size in Malta

Please fill in at least one answer

	Quantity	Unit (g/kg/ml/l)
1	Quantity	Unit (g/kg/ml/l)
2	Quantity	Unit (g/kg/ml/l)
3	Quantity	Unit (g/kg/ml/l)
4	Quantity	Unit (g/kg/ml/l)

REQUESTED DOCUMENTATION

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

Authorisation document from Zonal Rapporteur Member State;
Formal statement that the plant protection product is identical to that authorised by the reference Member State;
Letter of access of each active ingredient (in the event that ownership of data on active ingredient is different than applicant data);
List of studies for Data Protection in Malta. Please provide the list in '.xls' format as presented in Annex I;
SDS for the product in accordance with Regulation 1272/2008/EC as applicable;
SDS for each active substance and co-formulant in accordance with Regulation 1272/2008/EC as applicable

Note: All SDSs must be supplied to authorise a product

Original product labelling
Official translation in English (if original is not in English)
Official translation in Maltese (note that if Maltese alphabet is not used, the label [and application] will not be valid)

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

Please upload between 1 and 10 files

Upload files

Use this option to:

- attach any relevant supporting information as noted hereabove in the documentation checklist.
- upload proof of payment.

PAYMENT

Payment of €3,000 to be affected within 3 days from submission of application through

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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