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Notification of non-significant change to an authorised plant protection product
Please complete all relevant sections of this form. The completed form should be
submitted via email to applications@hse.gsi.gov.uk. Your email should include a
summary of the reason for changing the formulation. CRD will respond within 10
working days to inform you whether or not the notification has been accepted.
Part A
Notifier
Contact name (incl. title)
By completing this form I confirm that the information provided
is true to the best of my knowledge, information and belief.
Company name
Address
Telephone
Email
Date
Product Identity
Product Name
MAPP number
Most recent Notice of
Authorisation number
Authorisation holder
(include address)
Marketing company
(if different)
Type of non-significant formulation change requested
Alternative source(s) of chemically identical co-formulant(s)
Cation exchange in an anionic surfactant/dispersant
Addition of a marker substance already determined to be acceptable by CRD
(please indicate product name and COP number of the existing assessment below)
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PART B
Currently authorised formulation
This table must always be completed with the full details of the currently authorised formulation as given (or referred to) on the product’s most recent notice of authorisation:
Chemical name
CAS no (s)
Tradename(s)
Function
Content
(please add sufficient rows as required)
Proposed new formulation
This table must be fully completed with the complete new proposed formulation. Please highlight where this differs to the currently authorised formulation (above).
Chemical name
CAS no (s)
Tradename(s)
(please add sufficient rows as required)
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Function
Content
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PART C – This part should be copy/pasted as required to ensure there is a fully
completed table for each proposed alternative co-formulant.
Proposed alternative co-formulant
Currently authorised
Proposed alternative coformulant
Trade name
Classification from MSDS
(CLP codes only)
Primary constituent of co-formulant
Chemical name
Chemical structure
CAS number
Content
Additional constituent of co-formulant
Chemical name
Chemical structure
CAS number
Content
Additional constituent of co-formulant
Chemical name
Chemical structure
CAS number
Content
(Please add additional boxes for each significant component of the co-formulant to ensure
that the complete co-formulant is described).
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CRD use only
Officer
Date
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