Application Form CRD2
                Submission under Regulation (EC) No 1107/2009
           Commercial authorisation of a plant protection product via the
       Administrative Stream where no technical assessment/data evaluation
                                  is required.
                             When not to use this form
      Applications for:
        New commercial authorisation or new permit for trial purposes (use form 
         CRD1).
        Extension of authorisation for minor use (use form CRD3).
        Official Listing of an Adjuvant (use form CRD4).
        Administrative permit for trial purposes (use form CRD7).
        Standalone Technical Equivalence (use form CRD8).
        Emergency authorisations under Article 53 (use form CRD9).
        Pre-submission meeting (use CRD10).
        Renewal of an existing plant protection product (use form CRD-R).
        Biocidal product authorisation (see http://www.hse.gov.uk/biocides/index.htm).
                         By Post:  Applications Sift, Chemicals Regulation Division, Mallard 
                         House, Kings Pool, 3 Peasholme Green, York, YO1 7PX, UK 
      Application submission By Email: applications@hse.gov.uk
                         By ShareFile (cloud based file sharing system): Please request 
                         details of CRD’s ShareFile by emailing applications@hse.gov.uk
      CRD contact details 
      Telephone: 020 3028 1101 (International: (+44) 20 3028 1101)
      Enquiries Email: CRDInformationManagement@hse.gov.uk
      Website: http://www.hse.gov.uk/CRD/
                             How to complete this form
          Complete all parts of the form relevant to your application.
          All correspondence and enquiries will be sent to the contact named in the applicant 
         section (Part A) of this form unless otherwise informed.
          No sections of the form are protected.  Take care not to delete or amend existing 
         text.
          To check ‘tick boxes’, double click on the box, select ‘checked’ and press ‘ok’.
          ‘Copy and paste’ to add additional rows/tables where appropriate.
          For questions about this form, see CRD contact details above.
          All forms and supporting information must be submitted to applications@hse.gov.uk.
          Guidance on the applications process can be found in the Applicant Guide.
          Note if this application form is not fully completed your application may be rejected.
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        Form CRD2 Version 04/22
        Part A – Applicant details
        1      Application                                 The Authorisation Holder
               submitted                       Consultancy/Third Party                       
               by:
               Applicant      Contact name                                     Title*      
               contact            Company      
               details                name
                                   Address      
                                 Telephone      
                                      Email      
                                       Date      
                            I confirm that the information given in this application form is true to
                            the best of my knowledge, information and belief. 
                                (tick to confirm)
        2      Address for   Contact name                                      Title*      
               invoicing          Company      
                                      name
                                   Address      
                                 Telephone      
                                      Email      
        3           Purchase order number       
                                 (if needed)
          * for example; Mr, Mrs, Ms, Dr
        Using personal data
        HSE is under a legal duty to protect any personal information we collect and we will only use 
        that information in accordance with the law, including the General Data Protection Regulation
        (GDPR) (Regulation (EU) 2016/679), the Data Protection Act 2018, the Freedom of 
        Information Act 2000 and the Environmental Information Regulations 2004. We meet our 
        obligations as part of UK Government to safeguard data and prevent any unauthorised 
        access to it through use of technical, personnel and procedural controls.
        More details on Government security can be found on the Gov.UK Web site: 
        https://www.gov.uk/government/collections/government-security. In order to carry out our 
        functions and respond to enquiries effectively, we will sometimes need to share information 
        with other government departments, the emergency services, law enforcement agencies, 
        public authorities (such as local authorities and the Environment Agency) and organisations 
        acting on our behalf. However, we will only do this where it is required or permitted by law.
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          Form CRD2 Version 04/22
        Part B – Type of Application
        4      How many products does this application apply to
        4a     Application for 1 product
        4b     Application for 15 or more products that can be processed         
               as a ‘blanket amendment’                                      (complete Appendix 
               (only applies to changes which do not require a new MAPP      1)
               number to be issued)
        5      What type of application are you applying for
        5a     Authorisation of a new product identical to an EXISTING 
               authorised ‘parent’ product (specify below)
               (known as a 'back-to-back' application)
               Existing ‘parent’ product      MAPP number                     Notice of 
               name                                                           Authorisation 
                                                                              Number
                                                                                   
        5b     Authorisation of a new product identical to ONGOING applic-
               ation for a ‘parent’ product (specify below)
               (known as a 'back-to-back' application)
               Product name                   MAPP number                     ongoing COP 
                                                                              number
                                                                                   
        5c     Change in product tradename                                       complete 
                                                                              section G
        5d     Change in Authorisation Holder                                    complete 
                                                                              section G
        5e     Change in Marketing Company                                       complete 
                                                                              section G
        5f     Changes to authorised product identical to those considered
               for another authorised product
        5g     Extension to the expiry date 
               (specify below including need, justification, stocks held)
                    
        5h     Renewal of trials permits
        5i     Change of pack size (within existing range)                       
        5j     Commercial withdrawal of an authorised use                        
               (specify below including reason, stocks held)
                    
        5k     Other changes not covered above 
               (include ‘current’ details and ‘proposed’ changes)
                    
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          Form CRD2 Version 04/22
        Part C – Extent of authorisation
        (Note: If you are making a change to an existing product, you cannot change the extent 
        of authorisation using this form.  A change to a product using this form can only be GB 
        only to GB only, NI only to NI only or GB&NI to GB&NI.)
        6      Where will your application apply
        6a     Great Britain and Northern Ireland – where conditions of evaluation
               will be identical
        6b     Great Britain Only (Scotland, England and Wales)                         
        6c     Northern Ireland Only                                                    
        Part D – Product identity
        7      Identity of CURRENT product 
               (complete section 8 for a NEW product and to show changed details)
        7a                   Product name       
                          (or Code number)
        7b                    MAPP number      
                              (if applicable)
        7c     Authorisation      Company      
               holder                 name
                                   Address      
                                  Company      
                                Registration
                                    Number
        7d     Marketing          Company      
               company                name
                                   Address      
                                  Company      
                                Registration
                                    Number
        7e     Current Notice of                   
               Authorisation Number(s) 
               (NANUM(s))
        7f     Active substance(s) and content (list all using common names)
               Active                              g/kg        %w/w        g/l         %w/v
                                                                                            
                                                                                            
                                                                                            
                                                                                            
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          Form CRD2 Version 04/22