Notification Form
Fill in Word and mailto: notifications@skal.nl
To be filled in by Skal
Skal registration
Skal notification number
Date of notification received by Skal
A) Notifying country
1. Country
2. Competent authority
3. Date (DD/MM/YYYY)
4. Reference
B) Notified country/countries
1. Country/countries
2. Competent authority
Part C, D, E, F, G, H to be filled in by the notifying company – language
English
C) Product
1. Category of product
a. Unprocessed plant products
b. Unprocessed animal products
c. Aquaculture products and seaweed
d. Processed agricultural products for use as food
e. Processed agricultural products for use as feed
f. Seeds and propagation material
2. Product name
3. Country of origin
4. Description of the product (packaging size and
form, etc.) – please attach copied or scanned seal or
label
5. Identification of the lot (e.g. lot number, delivery
number, delivery date, etc.)
6. Other information:
6a. Delivered quantity of the notified lot
6b. Still in stock of the notified lot
6c. Other relevant information
D) Traceability
1. Producer - contact details - inspection (control)
body
The farmer/grower who has produced the primary product
2. Processor/seller in the country of origin - contact
details - inspection (control) body
The company that has processed/sold the product
3. Importer in the notifying country- contact details inspection (control) body
4. Wholesaler - contact details - inspection (control)
body
5. Retailer or other operator in the notifying country,
where the irregularity/contamination has been
detected - contact details - inspection (control) body
FR041.01, versie 6
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6. Other/Further actors
7. Notes on the traceability
Explain how the identification code of your company can be
linked to the identification code of the bought lot and the
identification code of the lot in which the irregularity has
been detected?
E) Irregularity, suspicion of an infringement, other problem raised
1a. Nature of the irregularity/suspicion of an
infringement/other problem raised. Which
irregularity/suspicion of an infringement/other
problem raised has been identified?
o
o
o
o
Residues
GMO
Fraud
Other, namely ...........
1b. In what aspect does it represent a breach of
Regulation ?
o
Residues: Art. 12 of R. 834/2007 and
Article 5 of R. 889/2008
GMO: Art. 9 of R. 834/2007
Fraud: Art. 91 of R. 889/2008
………..
o
o
o
2. Context of the detection of the
irregularity/suspicion of an infringement/other
problem raised - please attach a copy of invoice or
other supporting documents.
2a. Date of the detection of the irregularity/suspicion
of an infringement/other problem raised
(DD/MM/YYYY)
2b. Place of the detection of the
irregularity/suspicion of an infringement/other
problem raised
3. Analysis of the samples/tests (if any) - please
attach a copy of analysis report
3a. Date of sampling/testing (DD/MM/YYYY)
3b. Place of sampling/testing
3c. Date of the analysis-report (DD/MM/YYYY)
3d. Details (name of the laboratory, methods used,
results)
3e. Name of the substances found
3f. Level of the residues detected
3g. Is the level above the threshold allowed in food
(or feed) in general?
3h. Is the level for labeling of GMO-contents
overshot?
F) Market influence
1. Has the product been withdrawn from the market,
blocked or marketed?
2. Which actors have been already informed?
3. Are there other Member States affected?
G) Measures taken
1. Which voluntary measures been taken (on the
product/operator/market)?
2. Have any compulsory measures been taken?
3. What is the scope of the measures (national,
regional, exports, etc.)?
4. Date of entry into force: (DD/MM/YYYY)
5. Duration
6. Justification/ legal base of the measures
7. Which authority and/or body has adopted the
measures?
H) Other information/Evaluation
1. Probable cause
2. Statement that the contamination did not take
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place at your company
3. Other relevant information/Evaluation
I) Annexes
1. Scanned seal or label
2. Analysis results
3. Invoice
4. Certificate of import (in the EU)
5. Official transport document
(e.g.
CMR, bill of lading)
6. Scanned copy of certificate of supplier
7. Scanned copy of certificate of producer
8. List of clients/buyers including the following
information: delivery date – client name – country
client – article description - delivered amount – lot
number original lot – identification code delivery
Additional questions
1.
FR041.01, versie 6
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