BASIS® REGISTRATION LIMITED

STRICTLY CONFIDENTIAL

AN INDEPENDENT REGISTRATION SCHEME FOR THE PESTICIDE INDUSTRY

APPLICATION FOR REGISTRATION FOR THE AMENITY ASSURED STANDARD

COMPANY DETAILS:
Company name:
Correspondence address:
Town:
Postcode: / County (or country if not UK):
Telephone: / Mobile no:
E-mail address:
Website:
DETAILS OF THE PERSON RESPONSIBLE FOR IMPLEMENTING THE STANDARD:
Title: / ☐Mr ☐Mrs ☐ Ms☐Miss ☐Dr ☐Other (please specify)
Surname: / Forename(s):
Telephone: / Mobile no:
E-mail address:
You are reminded of the recommendation to obtain the literature relevant to the Amenity Assured Standard
I, the undersigned, agree to abide by the requirements of the Amenity Assured Standard. I agree to observe the decisions of the Registration Board made from time to time.
TYPE OF MEMEBERSHIP APPLIED FOR: / YES / NO
A) Full Membership / ☐ / ☐ /
B) Franchise Membership / ☐ / ☐ /
C) Associate Membership / ☐ / ☐ /
Signed: / Date: / Click here to enter a date. /
On behalf of:
Please return to: / Lindsay Smith-Boam
BASIS® Registration Limited,
St Monica’s House Business Centre,
39 Windmill Lane, ASHBOURNE, Derbyshire
DE6 1EY. Email / BASIS® REGISTRATION LIMITED
NO:………………………………………
OFFICE USE ONLY

BASIS® REGISTRATION LIMITED

STRICTLY CONFIDENTIAL

AN INDEPENDENT REGISTRATION SCHEME FOR THE PESTICIDE INDUSTRY

APPLYING FOR: / YES / NO
A)Full Membership (for companies using chemicals as part of a weed control contract) / ☐ / ☐ /
How many PA qualified operators are involved in weed control / contract application?
Who is your BASIS qualified adviser (name)?
BASIS Account No: / E-mail address:
Telephone No: / Mobile No:
Will you:
a) Supply chemicals only with application? / ☐ / ☐ /
b) Advise on choice of chemicals? / ☐ / ☐ /
c) Advise on application timing? / ☐ / ☐ /
d) Advise on application technique? / ☐ / ☐ /
e) Apply chemical on customers’ instructions? / ☐ / ☐ /
Are your spray operators certificated as required by the Control of Pesticide Regulations 1986? / ☐ / ☐ /
Do you undertake contracts for Local Authorities? / ☐ / ☐ /
Is registration for sale/supply of pesticides also requested? / ☐ / ☐ /
If yes, you will be emailed a BACCS Stores Inspection Application Form to be completed.
(Please note that this is a separate inspection scheme to the Amenity Assured Standard and carries a separate charge)
B) Franchise Membership (for companies operating as a franchise structure) / ☐ / ☐ /
How many franchiseesdo you have?
What is the total number of PA qualified operators?
Who is the contact person?
BASIS Account No: / E-mail address:
Telephone No: / Mobile No:
Will you:
a) Ensurethat all franchisees will complete and return the questionnaire audit and meet compliance criteria? / ☐ / ☐ /
b) Accept responsibility for all the franchise companies in relation to Amenity Assured Standard conduct, compliance and operational practices? / ☐ / ☐ /
c) Be responsible for payment of the Amenity Assured Standard fee(s) on the franchise company rates and pay with BASIS Registration Limited terms of trade? / ☐ / ☐ /
Is registration for sale/supply of pesticides also requested? / ☐ / ☐ /
If yes, you will be emailed a BACCS Stores Inspection Application Form to be completed.
(Please note that this is a separate inspection scheme to the Amenity Assured Standard and carries a separate charge)

BASIS® REGISTRATION LIMITED

STRICTLY CONFIDENTIAL

AN INDEPENDENT REGISTRATION SCHEME FOR THE PESTICIDE INDUSTRY

YES / NO
C) Associate Membership (for companies and organisations not actively involved in applying chemicals e.g. Manufacturers) / ☐ / ☐ /
What is the nature of activity of your company / organisation (e.g. Manufacturer, Trading, Professional Association)
Will you:
a) Support the principles and requirements as set out in the Amenity Assured Standard? / ☐ / ☐ /
b) Not conduct work of Amenity Weed or Pest Control within their own organisation? / ☐ / ☐ /
c) Be supportive of Integrated approaches for weed and/or pest control in Amenity Areas? / ☐ / ☐ /
d) Be supportive to BASIS Registration Limitedand its objectives in the Amenity Sector with qualifications, CPD and the Amenity Assured Standard? / ☐ / ☐ /
e) Be supportive of Amenity Industry Standard and frameworks (e.g. CRD National Action Plan, Amenity Forum) and their objectives? / ☐ / ☐ /
f) Conduct your own organisation in a manner which is commensurate with the aims and objectives of the Amenity Assured Standard? / ☐ / ☐ /
I, the undersigned, declare that the information given is correct, to the best of my knowledge
Signed: / Date: / Click here to enter a date. /
Position in the company:

Application for registration for the Amenity Assured StandardPage 1 of 3