DO NOT DETACH
Acknowledgement Slip
Name and address
For Official Use only
Ref no.
IMPORTANT
Please use BLOCK letters and black ink.
Send the completed form, together with all the required
supporting documentation to Organic Branch, Defra, Area 4D,
Nobel House, Smith Square, London SW1P 3JR.
If this is a request to extend an existing ingredient derogation please
enter the authorisation reference number in the following box:
On receipt of your application the acknowledgment
slip below will be returned to you stamped and
dated as an acknowledgement of your application.
If you do not receive acknowledgement within
10 working days of sending off your form, please
contact Organic Branch, Defra, Area 4D, Nobel
House, Smith Square, London SW1P 3JR Tel:
020 7238 5777/6059.
Please note that there is a charge for the assessment
of this application (see Annex C)
Section 1 – Details of applicant
1. Company
name
Address
Tel. No. (incl. national dialling code)
Fax No. (incl. national dialling code)
Email address
Inspection body of
the applicant and
licence number
Section 2 – Details of Ingredient Derogation
2. Ingredient
3. Product ingredient
is to be used in
Official Use
Only
Application for an ingredient
derogation under Commission
Regulation (EC) 207/93
OB 9 (Rev. 3/06)
Postcode
OB 9 (Rev. 3/06)
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4. Percentage that ingredient comprises in finished product
5. a) Amount of the ingredient to be
used in 3 months in kgs (if you
are applying for the first time) or;
b) Amount of the ingredient to be
used in 7 months in kgs (if you
are applying for an extension)
6. Please now complete the composition sheet at Annex A.
Section 3 – Supporting statement
In order for a derogation to be granted the ingredient must not be available in an organic
form on the European Market. Please supply a statement (or statements) from your supplier(s)
confirming that organic supplies of the ingredient are either not produced or are temporarily
unavailable on the EC Market. Additionally, if the reason for not using organic ingredients
is that the organic equivalent does not fit the required specification, then the precise
specification must be supplied.
If this is an application for an extension you will need to supply up-to-date
supporting statements.
Section 4 – Declaration
Declaration of the applicant:
The legal basis for my application is Council Regulation (EEC) No 2092/91 as amended
and Commission Regulation (EC) 207/93.
I declare that all the information I have entered onto this form is correct to the best
of my knowledge.
Signature
Date
Name in BLOCK letters
Position in the company
Department for Environment, Food and Rural Affairs
Application for an ingredient
derogation under Commission
Regulation (EC) 207/93
Your application form was received by Defra on the date
shown. Keep this receipt. It does not imply that your
application will be successful or that it is complete but
it does provide proof that your application was received
by Defra on that date.
Reference number
Please quote this in all future
correspondence about this application.
Receipt Stamp
OB 9 (Rev. 3/06)
Official Use Only
OB 9 (Rev. 3/06)
Name of the product
Recipe of the product at the time of processing
Name of ingredients % weight
Sum
Sum
Total ingredients of
agricultural origin 100%
Sum
List of processing aids and other products used
Any personal data supplied on this form, or in connection with this application, will be used
by Defra to contact you in connection with this application.
The data provided on the application form will be retained by Defra on a database containing
Annex A
Product Composition Sheet
Official Use Only
OB 9 (Rev. 3/06)
Organic agricultural
ingredients
Non-organic
agricultural ingredients
Ingredients of non-
agricultural origin
(see Annex VI A of Reg.
(EEC) No. 2092/91 as
amended)
Processing aids and
other products (see
Annex VI B of Reg.
(EEC) No. 2092/91 as
amended)
information of derogations for the use of non-organic
produce.
In addition to the database held by Defra, the European
Commission will hold any or all of the information you
provide on a database. The competent authority (i.e.
Defra and its equivalent in other Member States) and
other authorised agents (enforcement authorities) in each
Member State will have access to this database.
Defra may use the data related to this application for the
purposes of statistical analysis and research.
Information (including personal data) may also be
released on request, including under the Environmental
Annex B
The Data Protection Act 1998
OB 9 (Rev. 3/06)
Information Regulations, the Code of Practice on
Access to Government Information and the Freedom of
Information Act 2000.
Defra or its appointed agents may use the name, address
and other details on your application form to contact you
in connection with occasional customer research aimed
at improving the services that Defra provides to you.
Annex C
Charge for Ingredient Derogation
Soon after sending in your application form you will receive an invoice from Defra charging
you £38 for the assessment. Please DO NOT make a payment prior to being invoiced.
Three ways to pay:
Bank Transfer
Please make your payment directly into Defra Bank Account
Bank: Barclays Bank PLC
Branch: York
Address: 1-3 Parliament St. York YO1 8XD
Sort Code: 20-99-56
Account Name: Defra Receipts Account
Account Number: 30853585
Please ask your bank to quote reference ERGO
Credit Card
Please call Defra’s Finance Section on 01904 455 395
Cheque
Once you receive an invoice a cheque can be sent to: Defra ASD B Receivables, G37, Foss House,
1-2 Peasholme Green, York YO1 7PX.
Please quote your invoice number when corresponding with Defra’s finance section.
Batch location code (Defra use only, 8 digits)
To be completed by the Importer
Company
Contact name
Address
Postcode
Tel. No. (incl. national dialling code)
Fax No. (incl. national dialling code)
For Defra use only
RAMIS Customer No.
Site name:
Product code:
OF005
Additional Narration:
Qty: 1 Unit Price: £38 Invoice Total: £38
Cost centre:
13500 Objective: 00244 Account: 2986 Sub: 000 Project: 0000000
Signature
Date
Name in
BLOCK letters
Division
Tel. No.
OB 9 (Rev. 3/06)
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