/ Application for a licence to Import Biological Control Agents into St Helena
BIOSECURITY / Form issued pursuant to Regulation 3 (First Schedule) of the St Helena Customs (Export and Import Control) Regulations, 1988.
Please complete this form as fully as possible. If handwritten, please use BLOCK LETTERS. Failure to provide information as requested may result in delays in processing and/or your application may be declined.

Importer Details

Your Name / Contact person (if different)
Full Address
Work phone / Email / Fax

Supplier Details

Company Name / Contact person
Full Address
Work phone / Email / Fax
Date when the proposal was approved:
Details of Biological Control Agents
Scientific name
(Order: Family: Genus: Species) / Nature of material to be imported
(life stage, any host material required, etc) / Quantity
Details of Project Plan

Please give a summary of the proposed project plan below. Attach separately any technical protocols and other relevant documents.

How will the supplier ensure that source material is uncontaminated?
How will material be transported to the island?
Summarise the plan for release (including planned locations of initial releases).
Summarise the plan for mass-rearing (if appropriate).
Summarise the plan for post-release monitoring of dispersion and impacts.
Description of Consignment

Details of how the material is to be packaged and contained.

Quantity (Number of boxes/containers/packages etc.)

Voyage number and date of arrival in St Helena

Importer’s Declaration
I / We the undersigned hereby declare that the information provided above is accurate to the best of my / our knowledge, and understand that if a ‘Licence to Import’ document is issued, I / We must comply in full to the conditions attached to such a licence.
Signature: Name: Date:
I, the

Where to Send this Application When it is Completed

Biosecurity Officer, ANRD, Scotland, St Helena Island STHL 1ZZ
Email: Fax: +00 (290) 24603

Notes:

(1)  This form contains 3 pages. Applicants should ensure that the sheets and any supporting documentation are stapled and clipped together when submitted. ANRD will not accept applications comprising incomplete forms.

(2)  The data collected in this form will be kept in confidence. They may however be disclosed to other third parties on the Island, if such disclosure is necessary to facilitate consideration of the related application, or is in the public interest.