MIP-0002-E
Application for exemption for a
biocidal product
Information about the exemption
No
Fill in the information relevant to the exemption. Items marked with an asterisk (*) are, however, mandatory
1*
Reason for exemption
2*
Reason (Describe the reasons underlying the exemption)
3*
Validity period
4
Area of use (Describe how the product will be used)
5
Users (Specify who will use the product/perform the treatment)
6
Amount of product that will be needed (Include unit)
7
Area / volume to be treated? (Include unit)
8
Number of treatments
9
Additional information
a) Research and development
b) Limited and controlled use for a maximum period of 120 days(1)
c) Other cases than a and b
Information about the product
No
Information
10
Product name (indicate complete name)
11
Type of biocidal product
12a
For chemical biocidal products:
List the CAS-numbers and full names for each of the active substances in the product
Swedish product authorisation No (in
cases the product is or has been
authorised in Sweden)
Chemical biocidal product
Biological biocidal product
No
CAS no
Name of active substance
Mall-id: MIP-0002-E, 9
/1/2013
1
2
3
4
5
1
When use appears necessary because of an unforeseen danger which can not be controlled by other means.
Swedish Chemicals Agency
Mailing address
Visit & delivery
Invoicing address
Phone & fax
Internet
VAT No
Box 2
SE-172 13 Sundbyberg
Sweden
Esplanaden 3A
SE-172 67 Sundbyberg
Sweden
FE 124
SE-838 80 Hackås
Sweden
Phone +46 8 519 41 100
Fax +46 8 735 76 98
www.kemi.se
kemi@kemi.se
SE202100388001
MIP-0002-E
Application for exemption for a
biocidal product
Swedish Chemicals Agency
No
Information
12b
For biological biocidal products:
Type of organism
Micro-organism
Genetically modified organism
Nematodes, insects and/or arachnids
List the full name(s) of the active organism(s) in the biocidal product
No
Name of organism
1
2
3
4
5
Appendixes to the application (2)
Appendix no
Study/report/risk assessment for intended use
Information about the applicant
Company name/name
Organisation number
Street address
Telephone number
Postal code and town
Contact person
Country
E-mail address
Fax number
Invoicing address for application fee
The invoice shall be addressed to
Complete company name
The same address as above
Another address, specified here
Invoicing address
Contact person (name/e-mail/tel)
Postal code and town
Country
Please observe that all of the studies referred to in this application must be made available to the Swedish Chemicals Agency in full
text, also those that a Letter of Access provides for. A Letter of Access attached to this application should be written according to the
guidance provided for Letter of Access on the website of the Swedish Chemicals Agency
(http://www.kemi.se/upload/Bekampningsmedel/Biocidprodukter/Letter_of_access_English.pdf).
2
2 (3)
MIP-0002-E
Application for exemption for a
biocidal product
Swedish Chemicals Agency
Signature
Place and date
Signature
Name (please print) and company
Send the application to:
Kemikalieinspektionen
Box 2
172 13 Sundbyberg, Sweden
About payment of the application fee:
The Swedish Chemicals Agency (KemI) makes a decision on the application
fee and sends the decision together with an invoice. The invoice states the
amount to be paid and how to pay it.
A list of application fees is available at KemI’s website. There is also a tool
that helps you estimate the fee.
3 (3)