DUTCH INPUTS LIST T
Plant protection products form
DIL-PPF; Version 004; 12. 04. 2017
Instructions
 This form is for submission of new plant protection products and related products for inclusion in the Dutch inputs list.
 Only registered companies may submit products.
 Fill in the form by computer (no handwriting).
 Print form, sign, scan and send to FiBL by E-Mail (contact: see www.dutchinputlist.fibl.org).
1. Identification of the distributor in The Netherlands
Company name
Note: full details on distributor companies must be given
with a separate form
2. Description of the product and its uses
Trade name of the product (if applicable in Dutch)
Manufacturer
Other trade names of the same product
(if applicable, also outside The Netherlands)
Is the product identical with another product in
the Dutch inputs list?
☐ yes which one?
☐ no
☐ not known for certain
Name of active substance(s)
Content of substance(s) (in % or g/Liter)
Applied dose (in g a.i./ha)
Number of applications per season
In which crops can the product be used?
Use(s)
☐ fungicide, bactericide
☐ insecticide, acaricide
☐ molluscicide
☐ control of stored products’ pests
☐ attractant, repellent, trap
☐ pruning agent, trunc paint
☐ invertebrate biocontrol agent
☐ other: …
Other uses must be specified.
Does the product contain synthetic
nanoparticles?
☐ yes
☐ no
DUTCH INPUTS LIST T
Plant protection products form
DIL-PPF; Version 004; 12. 04. 2017
3. Details on compliance with the relevant EU and Dutch legislation
Compliance with the relevant EU and Dutch legislation must be ensured by the companies.
In this context, please tick all appropriate statements below.
☐
The product is registered by Ctgb as a plant protection product.
Number: …
☐
The product is registered by Ctgb as a biocide.
Number: …
☐
The product is registered by Ctgb as a adjuvant.
Number: …
☐
The substance is approved as a basic substance at EU level.
☐
The product is listed under RUB legislation.
☐
The product is permitted by a derogation for an emergency situation. Please provide evidence.
☐
A derogation for an emergency situation has been applied for, and is currently pending.
☐
The product belongs to a category where no permit is required for legal use in agriculture
(wound sealing, trunc paint).
For invertebrate biocontrol agents (including nematodes):
☐
The species is approved under the Dutch Flora and fauna legislation.
4. Checklist of necessary documentation
(use this section to check whether your submission contains all necessary documents)
Full composition and manufacturing process
☐ enclosed
This must be submitted for all products; requirements see
document Evaluation Criteria
Copy of product label /description of use
☐ enclosed
(if available, also in English)
Copy of document issued by registration
authorities (if applicable)
☐ enclosed
Safety data sheets (if applicable)
☐ enclosed
☐ not applicable
☐ not applicable
Confirmation of the absence of GMOs
☐ enclosed
only for certain products and components; see document
Evaluation Criteria. We strongly recommend using the
form provided on the website)
☐ not required
5. Confirmation and signature
The undersigned confirms that the information given in this form is correct, that the placing on the market
of the product complies with the relevant EU and Dutch legislation and that the company has read and
fully agrees with the General Business Contract published on the website of the Dutch inputs list.
place
date
Signature