Fillable Exca1fert EXCA 1 (Fert).indd

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Exca1fert EXCA 1 (Fert).indd

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1. Full name and
address of the
applicant
company
Postcode
Telephone No. (including national dialling code)
2. (a) Trade name of each product for which the certifi cate is requested.
(b) Please tick:
or Northern Ireland.
NO, if it may be legally sold in Great Britain or
Northern Ireland, but is not marketed in these countries.
Important:
When completing this form
you must
provide all the necessary information or else the form
will be returned
. This will inevitably cause delay as a
certifi cate cannot be issued without all the necessary
information requested on this form. Application for more
than one product may be made on one form.
Y
ou
You Y
must
allow 7 working days upon receipt for
processing. Please ensure that your application reaches
us in good time.
Application for an Export Certifi cate
to accompany a consignment of
fertiliser(s) for export
Please complete in BLOCK LETTERS
P.T.O.
FOR OFFICIAL USE ONLY
Ref. No:
Date Rec.
Date sent:
Data Protection Act 1998
In accordance with the Data Protection Act 1998 , Defra
informs you that any personal data supplied on this form
will be used to process your application for an export
certifi cate, and that it may disclose these data to any
person or organisation for the purposes for which they
were collected. Furthermore, information (including
personal data) may be released on request, including
under the Environmental Information Regulations,
and
the Freedom of Information Act 1998.
Yes
........
No
..........
. Address to which certifi cates
should be sent (if different
from that on page 1.)
Postcode
. Name of contact if queries
arise regarding application
Telephone number for contact
Please note that some queries may be of a technical nature. The appropriate contact need not be the person who submitted
the application, but the person best
able to
deal with any q
ueries
.
Please return the completed form to:
3
4
Email
Fertilisers@defra.gsi.gov.uk
EXCA 1 (FERTILISER) (Rev. 4/11)
Telephone N
umber
Email address
of company
Signature
Date
Name in
BLOCK LETTERS
Position in
compan
y
Please return the completed form to:
Fertilisers@defra.gsi.gov.uk
EXCA 1 (FERTILISER) (Rev. 4/11)
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Completed 18 November 2019

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