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PMPIN ABBREVIATED FORM
Section A: Premise Information
CBI
1.
Premise Name: ABC solutions pvt ltd
2.
Premise Physical Location: Panvel India
3.
Premise Telephone No.: 9167204526
4.
Responsible Authority: Prashant Agarwal
5.
Address: Panvel India
6.
Fax:
7.
PMPIN Type: Import
Section B: Chemical Identification Information
8.
CBI
Chemical:
CAS Name
IUPAC Name
CITRAL
CITRAL
9.
CAS Number (if available): 5392-40-5
10.
RTECS Number (if available):
11.
Molecular Formula:
12.
Synonyms:
13.
Trade Name: xz
Common Name
Section C: Production Import and Intended Use
CBI
14.
Total Quantity produced or imported in the first 12 months (Kg): 4000
15.
Estimate the new quantity of the new chemical used in any of the following categories (kg)
Site Limited
Industrial
Commercial
Consumer
None
4000
None
None
Section D: Occupational Exposure
16.
Type of Activity
Number of Workers
Exposure of Activity
None
None
Section E: Estimate Environmental Release and Disposal of the New Chemical
17.
Release Quantity
None
Release Media
Control Measures
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Section F: Regular Status in other countries (if available)
Country Name : None
Regulatory Status of the new chemical in that country: None
Is MSDS available for the new chemical in the country referred? No
Section G: Statement on Physicochemical Characteristics (if available)
Section H: Statement on Toxicological Effects of the Chemical
Section I: Statement on Environmental Effects of the Chemical
Section J: List other companies and their addresses if this is a joint submission
Company Name
Company Address
None
None
NOTARIZED CERTIFICATION
THE UNDERSIGNED CERTIFY THAT THE INFORMATION PROVIDED IN THIS FORM IS TRUE AND
ACCURATE.
NAME
DESIGNATION / POSITION
SIGNATURE
DATE
I acknowledge that this application form is a legally binding document, and I declare, under the penalties of perjury,
that the same has been accomplished in good faith, verified by me, and, to the best of my knowledge and belief, is
true and correct pursuant to the regulations issued under authority thereof.
(Notary Public)