Application for the permit to place plant protection products on the market and to use them in trials for research or development purposes according to § 20 (1) of the German Plant Protection Act (Pflanzenschutzgesetz)

Applicant (state person processing the application incl. e-mail address and telephone number), address of the person authorised to receive (fee) notifications:
     
    
Your reference (optional)     

to
Bundesamt für Verbraucherschutz und Lebensmittelsicherheit
Dienststelle Braunschweig
Bundesallee 51
38116 Braunschweig

I apply for the permit of the plant protection product stated below for trial purposes
	for use according to Art. 54 of Regulation (EC) No 1107/2009 (appendix A is enclosed, if the active substance is not yet known to the BVL or has not been approved in the EU)
	for placing on the market according to Art. 28 (2) (b) of Regulation (EC) No 1107/2009 as well as the transport within in the EU according to § 20 (1) of the German Plant Protection Act (Pflanzenschutzgesetz)

1.	Information about the trial(s):
1.1.	In which period (in years) shall the trial(s) be conducted?		from      to     
1.2.	Number of locations per year: 	     
1.3.	Size of the trial area per location:	     
1.4.	Comments/remarks:	    
1.5.	Pre-Application-ID given by the EFSA:	    
1.6.	Location of the trial(s) (please tick all relevant boxes):	
BW:		BY:		BE: 		BB: 		
HB:		HH: 		HE: 		MV: 		
NI: 		NW:		RP: 		SL: 		
SN: 		SA: 		SH: 		TH: 		

2.	
In general, all plant protection products applied for are considered harmful to bees. According to § 2 (1) of the German Bee Protection Ordinance (Bienenschutzverordnung), plant protection products which are harmful to bees must not be applied on flowering plants and other plants which may be attractive to bees; this also includes weeds. An exceptional permit for research and trial purposes according to § 3 of the German Bee Protection Ordinance (Bienenschutzverordnung) may be granted by the responsible local competent authority.

 I confirm that the plant protection products no.       listed in the table below will not be applied on flowering plants or other plants (including weeds), which may be attractive to bees.
 I intend to use the plant protection product no.       during the flowering period of plants. The LD50- und HQ-values listed under point 15 in the table below provide evidence that the product is not harmful to bees.

3.	Use of treated crops after harvest:
	Treated crops will not be used as food and/or feed.
	Treated crops shall be used as food and/or feed in compliance with the provisions of Regulation (EC) No 396/2005. A justification for compliance with the respective maximum residue level(s) is provided below.
Justification:
     

	3.Name of the plant protection product	4. Type of formulation	5. Type of pesticide 	6. Trial purpose	7. Total amount applied for (in kg or L)	8. Active substance(s), and content 
(in g/L, g/kg or CFU)	
Product 1							
Product 2							
Product 3							
Product 4							
Product 5							
Product 6							
Product 7							
Product 8							
Product 9							
Product 10							
Product 11							
Product 12							
Product 13							
Product 14							
Product 15							
Product 16							

	9. Crop(s) to be treated	10. Pests/
purpose	11. Max. application rate of the product per hectare 	12. Max. amount of the active substance per hectare 	
			a) per treatment	b) per year	a) per treatment	b) per year	
Product 1							
Product 2							
Product 3							
Product 4							
Product 5							
Product 6							
Product 7							
Product 8							
Product 9							
Product 10							
Product 11							
Product 12							
Product 13							
Product 14							
Product 15							
Product 16							

	13. Application method	14. Range of growth stages
(BBCH codes)	15. Risk to honey bees: LD50 and HQ values of the plant protection product or the active substance(s) at the highest application rate	
			a) LD50 acute oral	b) HQ acute oral	c) LD50 acute contact	d) HQ acute contact	
Product 1							
Product 2							
Product 3							
Product 4							
Product 5							
Product 6							
Product 7							
Product 8							
Product 9							
Product 10							
Product 11							
Product 12							
Product 13							
Product 14							
Product 15							
Product 16							

16. Comments/remarks:
     

Place and date	Company stamp and signature