FORM-I (See Rule 6) Application for registration of insecticides 1. (a) Name, address and status of the applicant. (b) Category of the industry - SSI/DGTD/MRTP/FERA/Others 2. Address of the premises where the manufacture will be done. 3. The common name and trade name of the insecticides which the applicant proposes to import or manufacture. 4. Whether the application is for import or for manufacture: i. In the case of import please state : a. Name and address of the manufacturer. b. Name and address of the supplier if he is duly authorized by the manufacturer. c. Is the insecticide registered in the country of manufacture. From which supplies are expected to be made. ii. In the case of manufacture please state: Whether this insecticide is meant for domestic consumption or for export or for both. 5. In the case of formulation, the sources of supply of technical grade material and its status of registration. 6. Chemical composition: i. Kind and name of active and other ingredients and percentages of each. ii. Stability in storage (as per details specified by the Registration Committee) iii. Shelf life claim. 7. Toxity of the products to human beings, wild life, aquatic animals (toxicological data to be enclosed as per details specified by the Registration Committee) 8.The plant diseases, insects and other noxious animals and weeds against which it is intended to be used (Published / authentic reports on bioefficacy of the insecticide to be enclosed as per details specified by the Registration Committee) 9. Instructions for storage and use including first -aid precautionary measures which are proposed for labeling. 10. i. Ten copies of specifications for produce quality and methods of analysis for Technical/Formulated compound (as applicable ) and its residues. ii. Analytical test report for the product quality (as may be specified by the Registration Committee) 11. Seven copies of the proposed labels and leaflets (including all printed or graphic matter which will accompany the package containing the insecticide) as per the Insecticides Rules, 1971. Manner of packing Particulars of fee deposited. Signature of the applicant with seal VERIFICATION I...................................................S/o............................................................................................. ...... do hereby solemnly verify that to the best of my knowledge and belief the information given in the application and the annexure and statements/accompanying, it is correct and complete. I further declare that I am making this application my capacity as.............................. and that I am competent to make this application and verify it by virtue of.....................................a photo / attested copy of which is enclosed herewith. Place......................... Signature................................... Date.......................... with seal.................................... NOTE: The application form including the verification portion must be signed in case of an individual, by the individual himself or a person duly authorized by him; in case of Hindu undivided family, the the Karta; in case of a partnership firm, by the managing partner; in case of a company, by a person duly authorized in that behalf by the board of Directors and in any other case by a person in charge of or responsible for the conduct of the business. FORM-III (See Rule 9) 1. Name address and status of the applicant : 2. Address of the premises where the manufacturing activity will be done. 3. Name of the insecticides with Name of the insecticides Registration No Date their registration number and date for which manufacturing license is applied (enclose copies of 2 certificates of registration duly signed by the applicant) 4. Whether any registration is 3 provisional, if so give particulars 5. Details of full time expert staff Name Qualification Experience connected with the manufacture 1. And testing of the insecticides in 2. The above unit: Whether all the facilities required under Chapter VIII of the Rules have been provided. Give full details in a separate sheet Particulars of feed deposited: Signature of the applicant VERIFICATION I.....................................S/o................................... do hereby solemnly verify that to the best of my knowledge and belief the information given in the application and the annexure and statements accompanying it, is correct and complete. Date: Signature with Seal Place:
