Guidance to designated national authorities on the operation of the Rotterdam Convention

Annex 7.5 Forms and Instructions

Annex 7.5.1 Submission of a Notification of Final Regulatory Action

Secretariat for the Rotterdam Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade

INSTRUCTIONS FOR SUBMISSION OF NOTIFICATION OF FINAL REGULATORY ACTION TO BAN OR SEVERELY RESTRICT A CHEMICAL

This document provides instructions for the completion of the form for notification of final regulatory action to ban or severely restrict a chemical. The procedure regarding notification is described in the Rotterdam Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade, Article 5.

I. Definitions

According to Article 3 of the Convention, the Convention applies to: (a) banned or severely restricted chemicals; and (b) severely hazardous pesticide formulations.

“CHEMICAL” means a substance whether by itself or in a mixture or preparation and whether manufactured or obtained from nature, but does not include any living organism. It consists of the following categories: pesticide (including severely hazardous pesticide formulations) and industrial.

“BANNED CHEMICAL” means a chemical all uses of which within one or more categories have been prohibited by final regulatory action, in order to protect human health or the environment. It includes a chemical that has been refused approval for first-time use or has been withdrawn by industry, either from the domestic market or from further consideration in the domestic approval process and where there is clear evidence that such action was taken in order to protect human health or the environment.

“SEVERELY RESTRICTED CHEMICAL” means a chemical virtually all use of which within one or more categories has been prohibited by final regulatory action in order to protect human health or the environment, but for which certain specific uses remain allowed. It includes a chemical that, for virtually all use, has been refused approval or been withdrawn by industry either from the domestic market or from further consideration in the domestic approval process, and where there is clear evidence that such action was taken in order to protect human health or the environment.

The Convention does not apply to: (a) Narcotic drugs and psychotropic substances; (b) Radioactive materials; (c) wastes; (d) chemical weapons; (e) pharmaceuticals, including human and veterinary drugs; (f) chemicals used as food additives; (g) food; (h) chemicals in quantities not likely to affect human health or the environment provided they are imported: (i) for the purpose of research or analysis; or (ii) by an individual for his or her own personal use in quantities reasonable for such use.

II. General instructions

These instructions are to assist DNAs in completing the Notification of Final Regulatory Action to Ban or Severely Restrict a Chemical form. They provide detailed explanation of the information required under the various sections of the form. Please study these instructions carefully before filling out the form.
The Notification form is available in English, French and Spanish. Countries may respond in any of these three languages.
Please type the information into the form.
If you wish to submit the Notification form electronically, please contact the Secretariat. Electronic submission will greatly facilitate the manipulation of the submitted information, and the Secretariat encourages DNAs to do so.
Where “Reference to the relevant documentation” is requested in the form, you should provide the source of the information reported. This can e.g. be published or unpublished documents, internal reports, etc.
Although you may attach copies of such relevant documentation, please note, however, that the form must be filled in with the relevant information, it is not sufficient to refer only to supporting documentation.
If additional space is needed, please continue on a separate sheet of paper, clearly indicating which section of the form the information is related to.
If you have any additional information that is not requested in the form, this may also be reported on a separate sheet of paper attached to the form.

Please return the completed form to:

Secretariat for the Rotterdam Convention
Plant Protection Service
Plant Production and Protection Division,
FAO
Viale delle Terme di Caracalla
00100 Rome, Italy
Tel: (+39 06) 5705 3441
Fax: (+39 06) 5705 6347
E-mail: [email protected]

Secretariat for the Rotterdam Convention
UNEP Chemicals
11-13, Chemin des Anémones
CH – 1219 Châtelaine, Geneva, Switzerland
Tel: (+41 22) 917 8183
Fax: (+41 22) 797 3460
E-mail: [email protected]

III. Instructions for specific sections of the form

PART I: PROPERTIES, IDENTIFICATION AND USES

1 IDENTITY OF CHEMICAL
1.1 Common name	· The chemical identified in Section 1.1 to 1.4 is the chemical for which the final regulatory action reported in Part II below should apply. · If reporting a final regulatory action that applies to a group of chemicals, please provide specific chemical name for each chemical covered by the final regulatory action.
1.2 Chemical name according to an internationally recognized nomenclature (e.g. IUPAC), where such nomenclature exists	· Chemical name, using an internationally recognized nomenclature must be provided, in order to allow for a precise identification of the chemical. · Please always indicate the nomenclature system used here.
1.3 Trade names and names of preparations	· Trade names and names of preparations of the chemical must be given.
1.4 Code numbers
1.4.1 CAS number	· The CAS (Chemicals Abstract Service) number must always be provided, in order to allow for a precise identification of the chemical being notified. · If reporting a final regulatory action that applies to a group of chemicals, please provide CAS-number for each chemical covered by the final regulatory action.
1.4.2 Harmonized System customs code	· The code number for the chemical from the Harmonized Commodity Description and Coding System, generally referred to as the Harmonized System, developed by the World Customs Organization (WCO), should be given.
1.4.3 Other numbers (specify the numbering system)	· Other numbers can also be given (i.e. EINECS, RTECS), please remember to specify the numbering system used.

1.5 Indication regarding previous notification on this chemical, if any

A notification can be revised with a resubmitted notification form. When revising a notification, you can either provide modifications to certain sections, or provide a new notification that replaces all previous notifications.

Please check Ö ONLY ONE of the three options to indicate whether this is:

a first time notification on this chemical from your country;
a modification of a previous notification on this chemical from your country;
a notification which replaces all previously submitted notifications on this chemical.

In case of a modification or a replacement of a previous notification, please indicate the date of issuing of the last notification.

1.6 Information on hazard classification where the chemical is subject to classification requirements

The hazard classification given here should be for the active ingredient. Please enter in the first column the hazard classification system and in the second column the hazard class the chemical is assigned to. In the first part, information on hazard classification of the chemical from international systems (e.g. WHO, IARC, etc.) must be given. In the second part, information from any other hazard classification system (e.g. EU, US EPA or other national hazard classification system) can be given.

1.7 Use or uses of the chemical

Please check Ö ONE OR BOTH of the chemical categories (pesticide or industrial) for which there is use in your country and describe the main and/or most significant uses of the chemical, within each category.

1.8 Properties

1.8.1 DESCRIPTION OF PHYSICO-CHEMICAL PROPERTIES

Please provide relevant information only, e.g. on description of the form, solubility in water and organic solvents, melting point and vapour pressure with an indication of the temperature

1.8.2 DESCRIPTION OF TOXICOLOGICAL PROPERTIES

Please provide relevant information only, e.g. on acute toxicity, short- and long-term exposure, effects on reproduction, mutagenicity and carcinogenicity. Please continue on a separate sheet of paper if needed.
Please indicate whether the information is based on national studies or taken from references. A reference to the relevant documentation should be given.

1.8.3 Description of ecotoxicological properties

Please provide relevant information only, e.g. on toxicity to fish, aquatic invertebrates, birds and bees. Please continue on a separate sheet of paper if needed.
Indicate whether the information is based on national studies or taken from references. A reference to the relevant documentation should be given.

PART II: FINAL REGULATORY ACTION

2. FINAL REGULATORY ACTION

2.1	The chemical is:	banned	OR	severely restricted
Please check Ö ONLY ONE of the two options to indicate whether the final regulatory action reported in the notification form is a ban or a severe restriction.
2.2	Information specific to the final regulatory action
2.2.1	Summary of the final regulatory action Please provide a summary description of the ban or severe restriction you are reporting on, taking into account what constitutes such an action according to the definitions given in Section II of these instructions.
2.2.2	Reference to the regulatory document Please provide a reference to the national regulatory document where the decision on the final regulatory action can be found.
2.2.3	Date of entry into force of the final regulatory action The date (day, month, year) of entry into force of the final regulatory action must be provided. Please note that this is the effective date when the regulatory action came into force for the chemical, not e.g. the date when the decision was taken or when the decision was published.
2.3	Was the final regulatory action based on a risk or hazard evaluation? If yes, give information on such evaluation				Yes		No
	· Please provide a summary description of the risk or hazard evaluation upon which the ban or severe restriction was based. · When providing such a summary, you might want to indicate whether: (i) the evaluation is based on a review of scientific data in the context of the conditions prevailing in the country; (ii) the documentation demonstrates that data have been generated according to scientifically recognized methods; (iii) data reviews have been performed and documented according to generally recognized scientific principles and procedures; (iv) the final regulatory action was based on a risk evaluation involving prevailing conditions within the country taking the action.
	Reference to the relevant documentation Please provide a reference to the relevant documentation.
2.4	Reasons for the final regulatory action
2.4.1	Is the reason for the final regulatory action relevant to human health?				Yes		No
	If yes, give summary of the known hazards and risks presented by the chemical to human health, including the health of consumers and workers Please check Ö ONLY ONE of the two options to indicate whether the final regulatory action was taken because of human health considerations. If you check Ö “Yes”, please provide a summary of information on the concerns your government had, relevant to human health, including the health of consumers and workers, when the government took the final regulatory action. Add a separate sheet of paper if necessary. It is extremely important to provide details regarding the reasons for the final regulatory action for each notification. The reasons for the decision should be relevant to the conditions of use in the reporting country. This information is essential for the Chemical Review Committee when reviewing the notification and making a recommendation on whether or not the chemical should be included in the PIC procedure. Reference to the relevant documentation Please provide a reference to the relevant documentation. Expected effect of the final regulatory action Please give an assessment of the expected improvement in human health due to the final regulatory action. Such an assessment might include a consideration of whether the final regulatory action led, or would be expected to lead: (i) to a significant decrease in the quantity of the chemical used or the number of its uses; (ii) to an actual reduction of risk or would be expected to result in a significant reduction of risk for human health, including the health of consumers and workers.
2.4.2	Is the reason for the final regulatory action relevant to the environment?				Yes		No
	If yes, give summary of the known hazards and risks to the environment Please check Ö ONLY ONE of the two options to indicate whether the final regulatory action was taken because of environmental considerations. If you check Ö “Yes”, please provide a summary of information on the concerns your government had, relevant to the environment, when the government took the final regulatory action. Add a separate sheet of paper if necessary. It is extremely important to provide details regarding the reasons for the final regulatory action for each notification. The reasons for the decision should be relevant to the conditions of use in the reporting country. This information is essential for the Chemical Review Committee when reviewing the notification and making a recommendation on whether or not the chemical should be included in the PIC procedure. Reference to the relevant documentation Please provide a reference to the relevant documentation. Expected effect of the final regulatory action Please give an assessment of the expected improvement in environment due to the final regulatory action. Such an assessment might include a consideration of whether the final regulatory action led, or would be expected to lead: (i) to a significant decrease in the quantity of the chemical used or the number of its uses; (ii) to an actual reduction of risk or would be expected to result in a significant reduction of risk for the environment.
2.5	Category or categories where the final regulatory action has been taken
Please check Ö ONE OR BOTH of the chemical categories (industrial or pesticide) for which the final regulatory action has been taken.
2.5.1	Final regulatory action has been taken for the chemical category					Industrial
	Use or uses prohibited by the final regulatory action Please list specifically the use or uses prohibited by the final regulatory action. Use or uses that remain allowed Please list specifically the use or uses that remain allowed.
2.5.2	Final regulatory action has been taken for the chemical category					Pesticide
	Formulation(s) and use or uses prohibited by the final regulatory action Please list specifically the use or uses prohibited by the final regulatory action. When reporting on pesticides please indicate whether the final regulatory action bans or severely restricts all formulations of the chemical or bans or severely restricts only certain types of formulations or certain concentrations of active ingredient of a chemical. Formulation(s) and use or uses that remain allowed Please list specifically the use or uses that remain allowed. If the final regulatory action bans or severely restricts only some types of formulations and concentrations of active ingredient, while other types of formulations and concentrations of active ingredient remain allowed, please list these in this section.
2.5.3	Estimated quantity of the chemical produced, imported, exported and used, where available.
State specifically, where available, the quantity in metric tons (MT) of the chemical produced, imported, exported and used annually, with the most recent data, specifying period and year(s). For pesticides, estimate the quantity of active ingredients. For formulated products, calculate the volume of active ingredients in individual products and include this in the total quantity.
2.6	Indication, to the extent possible, of the likely relevance of the final regulatory action to other states and regions
Please provide, to the extent possible, an indication on the likely relevance of the final regulatory action to other countries and regions. The information provided might include an assessment of whether the considerations that lead to the final regulatory action being taken are applicable only in a limited geographical area or in other limited circumstances. The information you provide may be useful for the governments of other countries with the same problem as you have already recognised and regulated. Also, this information is relevant to the Chemical Review Committee when reviewing the notification and making a recommendation on whether or not the chemical should be included in the PIC procedure.
2.7	Other relevant information that may cover:
2.7.1	Assessment of socio-economic effects of the final regulatory action An assessment of potential socio-economic effects at the national level, once the final regulatory action comes into force, can be provided.
2.7.2	Information on alternatives and their relative risks Views on availability of alternative substances or alternative strategies can be given, with their relative risks. Attach a detailed description where possible. If investigations or recommendations on possible alternative strategies to the regulated chemical have been discussed in connection with the final regulatory action, such as IPM strategies or industrial practices and processes (including cleaner technology), please provide detailed information.
2.7.3	Relevant additional information The DNA may include any information being of relevance to the final regulatory action, such as labelling requirements, transport regulations, etc.

PART III: GOVERNMENT AUTHORITIES

MINISTRY/DEPARTMENT AND AUTHORITY RESPONSIBLE FOR ISSUING/ENFORCING THE FINAL REGULATORY ACTION

The complete name of the institution, address, telephone, telefax or telex numbers, e-mail for the authority responsible for issuing/enforcing the final regulatory action should be given here.

DESIGNATED NATIONAL AUTHORITY

The complete name of the institution of the DNA, address, name and position of the person in charge, telephone, telefax or telex and e-mail must be provided for each notification form.

DATE, SIGNATURE OF DNA AND OFFICIAL SEAL

The date of issuance of the form, signature of the DNA and official seal must be provided for each individual form to ensure that each document obtains its legal status. If all or part of the information regarding this point is missing, the form will be considered incomplete and can not be accepted as an official notification.

Secretariat for the Rotterdam Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade

FORM FOR NOTIFICATION OF FINAL REGULATORY ACTION
TO BAN OR SEVERELY RESTRICT A CHEMICAL

a) IMPORTANT: See instructions before filling in the form

Country:

PART I: PROPERTIES, IDENTIFICATION AND USES

1. IDENTITY OF CHEMICAL

1.1	Common name
1.2	Chemical name according to an internationally recognized nomenclature (e.g. IUPAC), where such nomenclature exists
1.3	Trade names and names of preparations
1.4	Code numbers
1.4.1	CAS number
1.4.2	Harmonized System customs code
1.4.3	Other numbers (specify the numbering system)
1.5	Indication regarding previous notification on this chemical, if any
1.5.1	This is a first time notification of final regulatory action on this chemical.
1.5.2	This is a modification of a previous notification of final regulatory action on this chemical. The sections modified are:.................................................................................................
	This notification replaces all previously submitted notifications on this chemical. Date of issue of the previous notification:...........................................................................
1.6	Information on hazard classification where the chemical is subject to classification requirements
International classification systems		Hazard class






Other classification systems		Hazard class






1.7	Use or uses of the chemical
1.7.1	Pesticide Describe the uses of the chemical as a pesticide in your country:

1.7.2	Industrial Describe the industrial uses of the chemical in your country:

1.8	Properties
1.8.1	Description of physico-chemical properties of the chemical

1.8.2	Description of toxicological properties of the chemical (See also Section 2.4)

1.8.3	Description of ecotoxicological properties of the chemical (See also Section 2.4)

PART II: FINAL REGULATORY ACTION

2. FINAL REGULATORY ACTION

2.1	The chemical is:	banned		OR	severely restricted
2.2	Information specific to the final regulatory action
2.2.1	Summary of the final regulatory action

2.2.2	Reference to the regulatory document

2.2.3	Date of entry into force of the final regulatory action

2.3	Was the final regulatory action based on a risk or hazard evaluation? If yes, give information on such evaluation					Yes		No

	Reference to the relevant documentation

2.4	Reasons for the final regulatory action (See also Sections 1.8.2 and 1.8.3)
2.4.1	Is the reason for the final regulatory action relevant to the human health?					Yes		No
	If yes, give summary of the known hazards and risks presented by the chemical to human health, including the health of consumers and workers

	Reference to the relevant documentation

	Expected effect of the final regulatory action

2.4.2	Is the reason for the final regulatory action relevant to the environment?					Yes		No
	If yes, give summary of the known hazards and risks to the environment

	Reference to the relevant documentation

	Expected effect of the final regulatory action

2.5	Category or categories where the final regulatory action has been taken
2.5.1	Final regulatory action has been taken for the chemical category Use or uses prohibited by the final regulatory action						Industrial

	Use or uses that remain allowed

2.5.2	Final regulatory action has been taken for the chemical category Formulation(s) and use or uses prohibited by the final regulatory action						Pesticide

	Formulation(s) and use or uses that remain allowed

2.5.3	Estimated quantity of the chemical produced, imported, exported and used, where available
			Quantity per year (MT)			Year
Produced
Imported
Exported
Used

2.6	Indication, to the extent possible, of the likely relevance of the final regulatory action to other states and regions

2.7	Other relevant information that may cover:
2.7.1	Assessment of socio-economic effects of the final regulatory action

2.7.2	Information on alternatives and their relative risks

2.7.3	Relevant additional information

PART III: GOVERNMENT AUTHORITIES

MINISTRY/DEPARTMENT AND AUTHORITY RESPONSIBLE FOR ISSUING/ENFORCING THE FINAL REGULATORY ACTION

Institution
Address
Telephone
Telefax
E-mail address

DESIGNATED NATIONAL AUTHORITY

Institution
Address
Name of person in charge
Position of person in charge
Telephone
Telefax
E-mail address

Date, signature of DNA and official seal:__________________________________

Annex 7.5.2 Submission of Import Response

Secretariat for the Rotterdam Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade

INSTRUCTIONS FOR SUBMISSION OF AN IMPORT RESPONSE

This document provides instructions for the completion of the Importing Country Response form. The procedure regarding importing country response is described in Article 10 of the Convention. According to paragraph 2 of Article 10, the DNA must transmit to the Secretariat, as soon as possible, and in any event no later than nine months after the date of dispatch of the decision guidance document, a response concerning the future import of the chemical concerned. The response regarding future import can either be a final decision based on national legislative/administrative measures or an interim response.

I. General instructions

These instructions are to assist DNAs in completing the Importing Country Response form. They provide detailed explanation of the information required under the various sections of the form. Please study these instructions carefully before filling out the form.
The Importing Country Response form is available in English, French and Spanish. Countries may respond in any of these three languages.
Please type the information into the form.
If you wish to submit the Importing Country Response form electronically, please contact the Secretariat. Electronic submission will greatly facilitate the manipulation of the submitted information, and the Secretariat encourages DNAs to do so.
Where “Reference to the relevant documentation” is requested in the form, you should provide the source of the information reported. This can e.g. be published or unpublished documents, internal reports, etc.
Although you may attach copies of such relevant documentation, please note, however, that the form must be filled in with the relevant information, it is not sufficient to refer only to supporting documentation.
If additional space is needed, please continue on a separate sheet of paper, clearly indicating which section of the form the information is related to.
If you have any additional information that is not requested in the form, this may also be reported on a separate sheet of paper attached to the form.

PLEASE RETURN THE COMPLETED FORM TO:

II. Instructions for the specific sections of the form

SECTION 1. IDENTITY OF CHEMICAL

1.1	Common name	Please see the relevant Decision Guidance Document (DGD) when filling in this Section. The chemical name given here must be in accordance with the DGD. The chemical identified here is the one for which the response must be given under Section 5 OR 6 below, in accordance with Article 10, paragraph 5.
1.2	CAS number	Please see the relevant DGD when filling in this Section. The CAS-number of the chemical given here must be in accordance with the DGD.
1.3	Type of formulation and content of active ingredient	Please see the relevant DGD when filling in this Section. If this Importing Country Response relates to a severely hazardous pesticide formulation, the type of formulation and content of active ingredient given here must be in accordance with the DGD.

SECTION 2. THE IMPORT RESPONSE PROVIDED IN THIS FORM APPLIES TO THE FOLLOWING CATEGORY OR CATEGORIES

The category or categories checked here must be consistent with the categories listed for the chemical in Annex III of the Convention and/or the relevant section in the DGD for the chemical. The response given later in Section 5 or 6 must relate to the category or categories checked in this section, in accordance with Article 10, paragraph 5.

SECTION 3. INDICATION REGARDING PREVIOUS RESPONSE, IF ANY

Please note that you, according to Article 10, paragraph 2, must forthwith submit a revised response, should your country modify its response. Both a final decision as well as an interim response can be revised with a resubmitted completed import response form. The previous decision will always be replaced by the new response.

Please check Ö ONLY ONE of the options in section 3.1 and 3.2, to indicate whether the response given is a first time import response or is a modification of a previous response. In case of a modification of a previous response, please clarify through yes or no and indicate the date of issuing of the last import response.

SECTION 4. RESPONSE REGARDING FUTURE IMPORT

Please note that you, according to Article 10, paragraph 2, must transmit to the Secretariat, as soon as possible, and in any event no later than nine months after the date of dispatch of the decision guidance document, a response concerning the future import of the chemical concerned. The response regarding future import can either be a final decision based on national legislative/administrative measures OR an interim response.

Please check Ö ONLY ONE of the two options to indicate whether the response given in the form is a final decision OR an interim response.

SECTION 5. FINAL DECISION, PURSUANT TO NATIONAL LEGISLATIVE OR ADMINISTRATIVE MEASURES

This Section must be filled in ONLY WHEN a final decision has been taken.

FINAL DECISION, pursuant to national legislative or administrative measures

For 5.1 to 5.3	Please check Ö ONLY ONE of the three boxes to indicate whether the final decision on import is “no consent” or “consent” or “consent only subject to specified conditions”.
	5.1 Ö	No consent to import - should be checked if no import is allowed at all.
	5.2 Ö	Consent to import – should be checked if general regulatory practices apply, i.e. product registered for use, customs clearance or import licence required.
	5.3 Ö	Consent to import only subject to specified conditions - should be checked if there are special conditions to be met prior to import, e.g. special permit documents, import restricted to certain bodies, etc. Please also give the name and address of the competent authority where to apply for such special permit.
	According to Article 10, paragraph 9, a country that takes a decision not to consent to import of a chemical or to consent to its import only under specified conditions shall, if it has not already done so, simultaneously prohibit or make subject to the same conditions: (a) import of the chemical from any source; and (b) domestic production of the chemical for domestic use. Please check – Ö Yes OR Ö No – to confirm such action.
5.4	National legislative or administrative measure upon which the final decision is based In case of a final decision, it is necessary to indicate the national legislative or administrative measures upon which the final decision is based, in accordance with Article 10, paragraph 6. Any official documents, which further explain or implement the regulatory or import status of this chemical in the country, should be referenced.
5.5	Remarks This point seeks information on the status of registration and manufacture of the chemical in the responding country. Other remarks may include information in case registration has been denied, etc.

SECTION 6. INTERIM RESPONSE

This Section must be filled in ONLY WHEN no final decision has been taken. An interim response is valid during the period until a final decision is reached.

INTERIM RESPONSE

For 6.1 to 6.3	Please check Ö ONE of the three boxes to indicate whether the interim response on import is “no consent” or “consent” or “consent only subject to specified conditions”.
	6.1 Ö	No consent to import – should be checked if no import is allowed at all.
	6.2 Ö	Consent to import – should be checked if general regulatory practices apply, i.e. product registered for use, customs clearance or import licence required.
	6.3 Ö	Consent to import only subject to specified conditions - should be checked if there are special conditions to be met prior to import, e.g. special permit documents, import restricted to certain bodies, etc. Please also give the name and address of the competent authority where to apply for such special permit.
	According to Article 10, paragraph 9, a country that takes a decision not to consent to import of a chemical or to consent to its import only under specified conditions shall, if it has not already done so, simultaneously prohibit or make subject to the same conditions: (a) import of the chemical from any source; and (b) domestic production of the chemical for domestic use. Please check – Ö Yes OR Ö No – to confirm such action.
6.4	Indication of active consideration in order to reach a final decision As you are providing an interim response, please check ONLY ONE of the two options to indicate whether a final decision is under active consideration. Please also indicate whether any administrative action is being undertaken during the period a final decision is being considered and indicate, if possible, the approximate time anticipated before a final decision can be reached. Please give the complete name and address of the institution responsible for the process in order to reach a final decision.
6.5	Information or assistance requested in order to reach a final decision If additional technical information is required, this must be clearly stated e.g. more detailed information on ecotoxicity, characteristics of the chemical, etc. If assistance is requested from the Secretariat in evaluating the chemical, the specific areas of difficulty and the nature of the assistance requested should be indicated.
6.6	Remarks This point seeks information on the status of registration and manufacture of the chemical in the responding country. Other remarks may include information in case registration has been denied, etc.

SECTION 7. RELEVANT ADDITIONAL INFORMATION

If you would like to provide additional information that is not requested in the form, you may also do so on a separate sheet and attach it to the form.

SECTION 8. DESIGNATED NATIONAL AUTHORITY

The complete name of the institution of the DNA, address, name and position of the person in charge, telephone, telefax or telex and e-mail must be provided on each IMPORT RESPONSE form.

DATE, SIGNATURE OF DNA AND OFFICIAL SEAL

Secretariat for the Rotterdam Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade

FORM FOR IMPORT RESPONSE

b) IMPORTANT: See instructions before filling in the form

Country:

SECTION 1. IDENTITY OF CHEMICAL
1.1	Common name
1.2	CAS number
1.3	Type of formulation and content of active ingredient

SECTION 2. THE IMPORT RESPONSE PROVIDED IN THIS FORM APPLIES TO THE FOLLOWING CATEGORY OR CATEGORIES
	Pesticide
	Industrial
	Severely hazardous pesticide formulation

SECTION 3. INDICATION REGARDING PREVIOUS RESPONSE, IF ANY
3.1	This is a first time import response for this chemical in the country.
3.2	This is a modification of a previous response.
	The previous response was a final decision.
	The previous response was an interim response	Yes	No
		Yes	No
	Date of issue of the previous response:................................................................

SECTION 4. RESPONSE REGARDING FUTURE IMPORT
Final decision (Fill in section 5 below)			OR		Interim response (Fill in section 6 below)

SECTION 5. FINAL DECISION, PURSUANT TO NATIONAL LEGISLATIVE OR ADMINISTRATIVE MEASURES
5.1	No consent to import
	Is the import of the chemical from all sources simultaneously prohibited?	Yes	No
	Is domestic production of the chemical for domestic use simultaneously prohibited?	Yes	No
5.2	Consent to import
5.3	Consent to import only subject to specified conditions The specified conditions are:

	Are the conditions for import of the chemical the same for all sources of import?	Yes	No
	Are the conditions for domestic production of the chemical for domestic use the same as for all imports?	Yes	No
5.4	National legislative or administrative measure upon which the final decision is based Description of the national legislative or administrative measure:

	The complete name and address of the institution/authority responsible for issuing this national legislative or administrative measure:

5.5	Remarks
	Has there ever been a request of registration of this chemical in the country?	Yes	No
	Is this chemical currently registered in the country?	Yes	No
	Is this chemical manufactured in the country?	Yes	No
	Is this chemical formulated in the country?	Yes	No
	If yes to either one of these last two questions:
	Is this intended for domestic use?	Yes	No
	Is this intended for export?	Yes	No
	Other remarks

SECTION 6. INTERIM RESPONSE
6.1	No consent to import
	Is the import of the chemical from all sources simultaneously prohibited?		Yes	No
	Is domestic production of the chemical for domestic use simultaneously prohibited?		Yes	No
6.2	Consent to import
6.3	Consent to import only subject to specified conditions The specified conditions are:

	Are the conditions for import of the chemical the same for all sources of import?		Yes	No
	Are the conditions for domestic production of the chemical for domestic use the same as for all imports?		Yes	No
6.4	Indication of active consideration in order to reach a final decision
	Is a final decision under active consideration?		Yes	No
	The following administrative action is being undertaken during the period a final decision is being considered:

	Approximate time needed before a final decision can be reached:............................................ The complete name and address of the responsible institution/authority actively considering a final decision:

6.5	Information or assistance requested in order to reach a final decision The following additional information is requested from the Secretariat:

	The following additional information is requested from the country that notified the final regulatory action:

	The following assistance is requested from the Secretariat in evaluating the chemical:

6.6	Remarks
	Has there ever been a request of registration of this chemical in the country?		Yes	No
	Is this chemical currently registered in the country?		Yes	No
	Is this chemical manufactured in the country?		Yes	No
	Is this chemical formulated in the country?		Yes	No
	If yes to either one of these last two questions:
		Is this intended for domestic use?	Yes	No
		Is this intended for export?	Yes	No
	Other remarks

SECTION 7. RELEVANT ADDITIONAL INFORMATION

SECTION 8. DESIGNATED NATIONAL AUTHORITY
Institution
Address
Name of person in charge
Position of person in charge
Telephone
Telefax
E-mail address

Date, signature of DNA and official seal: ________________________________________