Application Form for the Registration of a Biopesticide Product in Partner States of the East African Community (EAC)

Product

Product Name(Brand Name)

Type of formulation(Crop Life Code)

Active Ingredient/Agents (Common Name)

Active Ingredient/Agents Concentration

Patent Status

Select patent Status

Patent Expiry Date

Quick Response Code

Applicant

Applicant Name(Corporate name of the company)

Applicant Status

Select Applicant Status

Business Registration Number

Physical Address

Postal Address

Telephone Number

Email Address

Website

Contact Person at Applicant Company

Contact Person Telephone Number

Country

Select Country

Local Agent

Local Agent Name (Corporate name of company if different from applicant)

Local Agent Status

Select Local Agent Status

Business Registration Number

Physical Address

Postal Address

Telephone Number

Email Address

Website

Contact Person at Local Agent

Contact Person Telephone Number

Purpose of application

Purpose of Application

Select purpose of application

Intended Use

Product Category

Select Product Category

Types of Use

Select types

Biopesticide Category

Select Biopesticide Category

Target Pests/Diseases

Select Target Pests/Diseases

Target Crops/Commodity

Select Target Crops/Commodity

Hazard Classification (For Biochemicals)

WHO Hazard Class of the formulated product

GHS classification of the formulated product (list all classifiable hazards)

Physical Hazards

Health Hazards

Environmental Hazards

Hazard Classification (For Biochemicals)

Proof Of Payment

Draft Label

Technical Dossier

Registration authorization letter: In case the applicant is not the owner of the TGAI/product, provide a letter in which the owner of the TGAI/product authorizes the applicant to apply for registration;