Application Form for Registration of Fertiliser (Supplementary Substance)

APPLICATION FORM FOR REGISTRATION OF FERTILISER (SUPPLEMENTARY SUBSTANCE)

Application form is presented in accordance with Section 4 of Law No. 156/1998 Coll. on fertilisers, supplementary soil substances, supplementary plant preparations and substrates and on agrochemical testing of agricultural land, subsequently amended (Law on fertilizers).

Accepter:
Central Institute for Supervising and Testing inAgriculture
Department of Fertilisers
Za Opravnou 4
150 06 Praha 5 – Motol / Place for stick a fee stamps on – evidence of payment ofadministrative charge (3000 CZK)
Official record in CISTA
Reference number:
attendance stamp and internal number

1. Applicant

(encircle the answer) /

is producer

yes

no

is legal person

yes

is importer /

yes

/ is natural person /

yes

1.1 /

Business name/ Name, surname and degree

1.2 / Registered office / place of residence
Street
Municipality /

Post code

Telephone

Fax

Company registration number

Telephone / / / e-mail
2. /

Statutory body, member

Name, surname and degree

position

Name, surname and degree

position

Name, surname and degree

position
3. /

Attorney in-fact of acting with CISTA

Name, surname and position

Street

Municipality

Telephone / / / e-mail
4. /

Producer

State

4.1 /

Business name/ Name, surname and position

Company identification number

4.2 / Registered office / place of residence

Street

Municipality

/ Post code

Telephone

/ Fax
5. /

Name of Fertiliser

(Supplementary substance)
5.1 /

Type of Fertiliser

5.2 /

Kind of Fertiliser (Supplementary substance)

Inorganic

/ Straight

Compound

With addition of micro-nutrients

With micro-nutrients only

/
Liming material

Organic

Organo-mineral

Supplementary substances

/ Supplementary soil substances

Supplementary plant preparations

Substrates
5.3 /

Weight or volume of packing / supply

Enclosures of application form are necessary part of whole documentation. Application form without these enclosures will be recognised as incomplete and applicant will be called to complete it (Section 5 para 1 of Law No. 156/1998 Coll.). List of necessary enclosures is below.

Place

/ Rubber stamp /

Name, surname and signature

of statutory body

Date

Warning – whole procedure of fertilisers registration (including application presentation) is carried out in Czech!

List of required enclosures to Application form for registration offertiliser (supplementary substance)

Enclosure No. 1 / Technical product documentation, for example safety data sheet, technical standard, product sheet or technical specifications published by producer, featuring content of particular fertiliser components and content of hazardeous elements (at nutrients also their form and solubility), fertiliser grain size and fertiliser grinding finesess; Product Data Sheet at imported fertiliser; this documentation is mentioned as a part of enclosure or separately
Enclosure No. 2 / Packaging specifications including definition of size and material of applied package and sorts of group packaging.
Vehicles specifications (eventually container specifications) of bulk fertiliser
Enclosure No. 3 / Instructions for use (preferably in electronic form) containing especially range and manner of use and storage conditions including other obligations mentioned in Law No. 156/1998 Coll. Section 7
Enclosure No. 4 / Manufacturing process description including list of raw materials used for manufacturing together with their quality indexes
Enclosure No. 5 / Authorized subject documentation attesting there are expectations for permanent observance of manufacturing declared quality. If there isn´t the documentation at a domestic producer workers of CISTA (department of fertilisers registration) will carry out an audit during a course of proceedings
Enclosure No. 6 / Confirmation of authorized body (Ministry of Industry and Trade that exploits results of accredited laboratory No. 1167.2 – workplace of Research institute of industrial chemistry in Pardubice) that a product is not an explosive substance in accordance with Law No. 61/1988 Coll. 21
Enclosure No. 7 / Report or review of fertiliser features testing (biological testing) according to Law No. 156/1998 Coll. Section 4 para 5, 6, 7
Enclosure No. 8 / An assessment of Ministry of Health of the Czech republic according to Law No. 20/1966 Coll. on care of people health
Enclosure No. 9 / An assessment of product fire safety according to Law No. 133/1985 Coll., (Ministry of Internal Affairs – Technical institute of fire protection)
Enclosure No. 10 / Enlistment according to harmfulness for bees in accordance with Law No. 147/1996 Coll. and Decree No. 40/1997 Coll. and Decree No. 84/1997 Coll. (Bee research institute, Dol u Libčic)

CISTA specifies if enclosures 4 – 10 presentation is necessary for every particular application

Submit a fertilser sample for an assessment of chemical and physical attributes together with a filled application

Information for applicants:

In point No. 1 / delete as appropriate
In points No. 1.1, 1.2, 5.1, 5.2
(* marked) / juridical person fills in business name, registered office, eventually juridical form of business; natural person fills in first and last name, place of residence.
If there are other telephone and fax numbers they are mentioned in an enclosure
In point No. 2 / statutory body is mentioned according to Abstract of the Commercial Register
In point No. 3 / if statutory body confers authority on other person than company employee for act with CISTA it is necessary to present a warrant of attorney and mention an address different from applicant address
In point No. 5., 5.1, 5.2 / producer that is an applicant at the same time fills in data not mentioned in an application yet; telephone and fax numbers are unnecessary at a foreign producer
In point No. 5.1 / company registration number is mentioned at a domestic producer only
In point No. 6 / Czech name of fertiliser is mentioned in accordance with Law No. 156/1998 Coll.
In point No. 6.1 / type of fertiliser and its appropriate number marking is mentioned according to Decree No. 474/2000 Sb., issued for an implementation of Law on fertilisers Section 4 para 4, 10
In point No. 6.2 / it combines appropriate column tick with word completion, eventually applicant declares that fertiliser contains addition of micro-nutrients, vitamins, growth stimulators…, for example:
- mineral straight fertiliser „nitrogenous“, „phosphatic“, „potassic“
- mineral compound fertiliser ”NP”, ”NK”, ”PK”, ”NPK”
- fertilizer with micro-nutrients only – particular micro-nutrients are mentioned
- liming material „very fine-ground limestone“, „dolomitic limestone“,...
- organic fertiliser „glue-free bone meal“ „ground horn“…
- organo-mineral fertiliser “liquid fertiliser with guano”, “mixture of mineral nutrients with bone meal“…
- supplementary plant preparations “mixture of growth stimulators and vitamins“
- supplementary soil substances “polyacrylamide-based
preparation”
- substrate specified for „houseplants growing“
In point No. 6.3 / applicant declares all used packaging sizes

Fill in the application form legibly - manually in block letters, by typewriter, by PC