APPLICATION FOR EXEMPTION FROM THE DEFENCE SECTOR’S CRITERIA DOCUMENT – CHEMICAL SUBSTANCES, CHEMICAL PRODUCTS AND ARTICLES

Applying organisation / Date / Yourreference
Contact person / Telephone number / E-mail
Recipient in FMV (Project/Person)
  1. The application concerns (tick the relevant box)

Exemption for a chemical product (go to 2A)
Exemption for substance(s) in an article (go to 2B)

2A. Application for a chemical product

Trade name for chemical product (enclose a Safety Data Sheet according to current legislation in the European Union (EU))
Classification/Labelling including risk phrases or hazard statements
Application/area ofuse
Estimatedquantity
Reason for applying for an exemption (tick the relevant box/boxes)
The chemical product shall be avoided acording to the Criteria document table 1
The chemical product contains substance(s) that are restricted according to the Criteria document table 2
Give chemical name, CAS-no and classification for the substance/substances:
Chemicalname / CAS-no / Classification
Chemicalname / CAS-no / Classification
Is/are the substance/substances included in the Candidate list? Yes No
Is/are the substance/substances included in Annex XIV of the REACH-regulation? Yes No
Briefly describe why an alternative chemical product (not covered by the restrictions in the Criteria document) cannot be used. Also state if work on substitution of the chemical product is on-going, and if so, how this work is pursued.
Comments

2B. Application for substance(s) in an article

Designation of the article and/or part of article (materiel) (information can be enclosed)
Where does/do the substance/substances occur in the article?
Estimated quantity of the substance/substances in the article?
Reason for application for exemption
The article contains intentionally added substance(s) restricted according to table 3 of the Criteiadocument.
State chemical name, Cas-no, estimated percentage by weight in the article and classification of the substance/substances:
Chemicalname / CAS-no / Percentage by weight in the article / Classification
Chemicalname / CAS-no / Percentage by weight in the article / Classification
Is/are the substance/substances included in the Candidate list? Yes No
Is/are the substance/substances included in Annex XIV of the REACH-regulation? Yes No
Briefly describe why an alternative chemical product (not covered by the restrictions in the Criteria document) cannot be used. Also state if work on substitution of the chemical product is on-going, and if so, how this work is pursued.
Comments

3. Information regarding work on substitution for substances included in the Candidate list or in Annex XIV of REACH

State which actions, such as substitution, that will be taken to ensure continued delivery of the chemical product or article (since substances included in the Candidate list may be subjec to auhorisation and substances included in Annex XIV are subject to authorisation):

4. Justification for exemption

Is there any hindrance for applying for exemptions, for example restrictions or bans against use under legislation in force?
Yes No
Grounds for use
Risk assessment of the relevant application

5. Other information

Signatureof the applicant

Place and date
Signature
Clarification of signature and Title

Version 2018-02-09