ANNEX IIISupplementary provisions
ANNEX III Notification of an active substance according to Article 4 The notification shall be made on paper and sent by registered mail to European Commission, DG Health and Consumer Protection, unit E3, B-1049 Brussels, The notification shall be submitted in accordance with the following model. MODEL 1. Identification data on the notifier 1.1. Name and address of the producer including the name of the natural person responsible for the notification and further engagements resulting from this Regulation: 1.1.1. (a) Telephone No: (b) Fax No: (c) E-mail address: 1.1.2. (a) Contact: (b) Alternative: 2. Information to ensure identification 2.1. Common name (proposed or ISO-accepted) specifying, where relevant, any variants thereof such as salts, esters or amines produced by the manufacturer: 2.2. Chemical name (IUPAC and CAS nomenclature): 2.3. CAS, CIPAC and EEC numbers (if available): 2.4. Empirical and structural formula, molecular mass: 2.5. Specification of purity of the active substance in g/kg or g/l as appropriate: 2.6. Classification and labelling of the active substance in accordance with the provisions of Council Directive 67/548/EEC ( 1 ) (health and environment effects). The notifier confirms that the above information submitted on … (date) is honest and correct. Signature (of the person competent to act for the company mentioned under 1.1). … ( 1 ) OJ 196, 16.8.1967, p. 13 . Directive as last amended by Directive 2006/121/EC of the European Parliament and of the Council ( OJ L 396, 30.12.2006, p. 850 ), as corrected by OJ L 136, 29.5.2007, p. 281 .