Health and Safety
FEPA1 - Non-Agricultural Product Application Form
*Position in company
*Select relevant company type(s), enter details and select Add. The Approval Holder, Marketing Company and Invoice
Company are mandatory.
(if different to Approval Holder)
Address Line 1
(eg building name)
Address Line 2
Address Line 3
Details of companies required for this application
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Composition Details - Active and Non-Active Ingredients
Are the non-active ingredients Commercial in Confidence?
*Select whether details are for an active or non-active ingredients and enter the remaining details, select Add. Repeat to
add details for more than one composition.
*Name of component
Trade name of component
Source of manufacture
*Technical concentration (%w/w)
Technical concentration (gl
*EINECS/ELINCS CAS No
*Classification and Risk Phrases
List of active and non-active ingredients
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Other classification information
*Classification and risk phrases for full formulated product
Flash point (°C)
Other formulation, packaging and application information
Dry docking interval in months (antifouling products only)
*Type of formulation - List 1
*Type of formulation - List 2
Type of coating (anti-fouling product)
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Packaging and application information
*Enter details below and select Add. Repeat to add more than one set of details.
*Who will use the product?
*Application rate for the active
*Application rate for the product formulation
List of packaging and application information
Use patterns and efficacy claims
*Target pest(s) / organism(s) and beneficial effects arising from use
*Directions for use
If more space is required than is available in any section of this form, please use the additional information field
Any other additional information
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Please note, failure to complete this form fully or supply the information requested below will result in a delay in
processing this application.
Please indicate the documents you are attaching and provide details below. Select the Add Attachments button to
create the attachments. A limit of 5 documents is allowed with this application. If you have attachments which cannot be
included, please send them to the address available in the ? button
Material Safety Data Sheets for all substances (they should be less than 5 years old and in English)
Draft product label
Letter(s) of access (if appropriate)
Letter(s) of Intent to Supply active substance from manufacturer (if appropriate)
Details of attachments
*Approval is a legal requirement and it would be an offence to advertise, sell, supply, store or use non-approved
pesticides or use an approved pesticide in a manner that does not comply with the conditions of approval.
*I confirm that the information given in this application form is true to the best of my knowledge, information
Please check your email address below. Ensure that you change if incorrect as this is the email address that
your acknowledgement and a copy of the form will be sent to.
: You may experience intermittent issues using the '
' feature. Please bear with us, we are currently
investigating and hope to implement a solution as soon as we can.
In the meantime, if you
experience issues, please send your attachment(s) seperately to the following email address
quoting the name of your company and the date you submitted this form.
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