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Application Form for the Approval of 'Own-Use' of Imported Pesticides Identical to Products Approved under the Plant Protection Products Regulations

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. 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 of Plant Protection Product

Type of Plant Protection Product

Check all that apply

Fungicide
Molluscicide
Insecticide
Repellent
Herbicide
Rodenticide
Plant growth regulator
Bactericide
Other:

DETAILS OF APPLICANT (PERMANENT NATIONAL ADDRESS)

Are you a retuning 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 GROWER (IF DIFFERENT FROM APPLICANT)

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

DETAILS OF REFERENCE PRODUCT

Name or reference product registered in Malta

Registration number in Malta

Expiry date of registration in Malta

Answer must be greater or equal to 08.10.2024

DETAILS OF PRODUCTS TO BE IMPORTED

Details of products to be imported

Please fill in at least one answer

	1	2	3	4	5
Countries from which the product will be imported¹	1	2	3	4	5
Name(s) of the product in these countries	1	2	3	4	5
Registration No(s) of the product in these countries	1	2	3	4	5
Name(s) of approval holders	1	2	3	4	5
Active ingredient(s) and concentration(s) in formulation	1	2	3	4	5
Formulation type (e.g. soluble concentrate, water dispersible granule, etc.)	1	2	3	4	5
Is the form of the packaging of the imported product equivalent to the reference product?²,³ (yes / no)	1	2	3	4	5

Notes:

¹The product must be approved for marketing and use in the country from which it will be imported.

²The 'form of packaging' refers to the form of the package as it is sold and used by end-users, example: bottles, cans, drums, etc. This should not be confused with the outer package that eventually is used for the transport of products.

³Yes / No answers only

DETAILS OF AGRICULTURAL LAND REGISTERED ON BEHALF OF THE GROWER

Details of agricultural land registered on behalf of grower

Please fill in at least one answer

	Parcel ID	CSP ID
1	Parcel ID	CSP ID
2	Parcel ID	CSP ID
3	Parcel ID	CSP ID
4	Parcel ID	CSP ID
5	Parcel ID	CSP ID
6	Parcel ID	CSP ID
7	Parcel ID	CSP ID
8	Parcel ID	CSP ID
9	Parcel ID	CSP ID
10	Parcel ID	CSP ID

Number of IACS Registration Certificates attached with this form

Only numbers may be entered in this field.

PACKAGING

Details of product intended to be imported

Please fill in at least one answer

	Package size (Kg/g/l/ml)	Number of units intended to be imported
1	Package size (Kg/g/l/ml)	Number of units intended to be imported
2	Package size (Kg/g/l/ml)	Number of units intended to be imported
3	Package size (Kg/g/l/ml)	Number of units intended to be imported
4	Package size (Kg/g/l/ml)	Number of units intended to be imported
5	Package size (Kg/g/l/ml)	Number of units intended to be imported

REQUESTED DOCUMENTATION

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

Copy of the certification for Professional User of Plant Protection Products issued by the MCCAA.
IACS registration certificates of respective agricultural land.
Proof of payment relevant to this application form.

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 hereabove in the documentation checklist.
- upload proof of payment.

PAYMENT DETAILS

Payment of €20 has to be affected upon submission of application

Payment method

Choose one of the following answers

Bank transfer
Cheque (payable to MCCAA)
EPOS Machine (available at the MCCAA premises in Blata l-Bajda, Malta)

For cheques to be valid and accepted, payable amount should be that of over €20

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 (including any documents mentioned therein) 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. I confirm that I have attached all relevant documents with this application form.

Data Protection Declaration

Check all that apply

Personal dat provided in your application will be processed by the Malta Competition and Consumer Affairs Authority ("the Controller"), in accordance with the provisions of the General Data Protection Regulation (Reg. 2016/679), the Data Protection Act (Chapter 586 of the Laws of Malta) for licensing and administrative purposes and to comply with the Controller's legal obligations. Upon approval of your application, the Controller will process your personal data in relation to the purpose for which such data was submitted. For further information on how your personal data will be processed refer to the Controllers's privacy policy.
I, hereby grant my consent to the Malta Competition and Consumer Affairs Authority for the processing of my personal data in accordance with the above Data Protection Statement.

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