Application - Derogation research and development
(plant protection products)
In accordance with Regulation (EC) No 1107/2009
Productinformation
If the product contains a genetically modified organism, this form should not be used. Please contact the Swedish Chemicals Agency for more information.
No. / Information1 / Name of the product / SDS[1] attached / Authorisation no.
2 / Type of product
<Choose alternative>ChemicalBiological / Function
<Choose alternative>AC - AcaricideAT - AttractantBA - BactericideDE - DesiccantEL - ElicitorFU - FungicideHB - HerbicideIN - InsecticideMO - MolluscicideNE - NematicideOT - Other treatmentPA - Plant activatorPG - Plant growth regulatorPruningRE - RepellantRO - RodenticideST - Soil treatmentVI - Virus inoculation / Additional function (if applicable)
<Choose alternative>AC - AcaricideAT - AttractantBA - BactericideDE - DesiccantEL - ElicitorFU - FungicideHB - HerbicideIN - InsecticideMO - MolluscicideNE - NematicideOT - Other treatmentPA - Plant activatorPG - Plant growth regulatorPruningRE - RepellantRO - RodenticideST - Soil treatmentVI - Virus inoculation
3:1 / Active substance/organism / CAS no./Strain and culture collection
3:2 / Active substance/organism / CAS no./Strain and culture collection
3:3 / Active substance/organism / CAS no./Strain and culture collection
4 / Company responsible for placing the product on the market[2]
Signature[3]
5 / Applying company / DateSignature / Printed name
Send the documentation[4] to:
and/or to:
Swedish Chemicals Agency
Box 2
SE-172 13 Sundbyberg, Sweden / Payment[5]:
The Swedish Chemicals Agency sends an invoice to the applicant. The invoice states the amount to be paid and how to pay it.
A list of application fees is available at the Swedish Chemicals Agency’s website.
Applicant
No. / Information6 / Name / Organisation No/VAT No
Mailing address / Telephone no. (incl. country code)
Postal code and town / Contact person
Country / E-mail address
Representative (if applicable)
No. / Information7 / Company name / Organisation No/VAT No
Mailing address / Telephone no. (incl. country code)
Postal code and town / Contact person
Country / E-mail address
8 / A representative should prove the appointed level of representation with a power of attorney from the applicant in original.
Power of attorney is attached
Application fee
No. / Information9 / Application fee will be paid by
Applicant
Representative
Invoicing address / Contact person (name/e-mail/tel)
Postal code and town / Country
Research and development
Permit can be granted for experiments or tests for research and development purposes involving the release into the environment of an unauthorised plant protection product or involving unauthorised use of a plant protection product.
No. / Information10 / Reason (describe why a derogation is needed, please use annexes)
11 / Area of use (describe which crop the product will be used in, and against what pest/for what reason)
12 / Dose/ha / Dose active subst./ha / Number of applications / Time between applications (days)
13 / Growth stage at application (BBCH) / Post harvest interval (PHI)
14 / Additional information (please use annexes)
Test program (if applicable)
No. / Information15 / Swedac no.
Annexes
Please observe that all of the studies referred to in this application must be made available to the Swedish Chemicals Agency in full text, including those where access is provided through a Letter of Access. A Letter of Access should in relevant cases be attached to this application.
Annex no. / Issue / Comments1 (3)
[1]Safety datasheet.
[2]Needed only if the product is not authorised as a pesticide in Sweden.
[3]If the signature is done by someone other than the applying company, a power of attorney confirming the right to sign the application on behalf of the applicant should be submitted.
[4] The first page of this application form as well as Letter of Access and power of attorney should be submitted as signed originals. All other documents, including the remainder of the application form, can be delivered on CD or in another digital form.
[5]According to the Swedish Pesticide Fees Ordinance (2013:63).