ANNEX IISupplementary provisions
ANNEX II Format for application, as provided for in Article 5(1) The application shall be in writing, signed by the applicant, and sent by registered mail to the rapporteur Member State listed in column B of Annex I and to the co-rapporteur Member State listed in column C of Annex I. A copy of the application without the updating statement shall be sent to the European Commission, DG Health and Consumers, unit E3, 1049 Brussels, Belgium and to the Authority, European Food Safety Authority, Largo N. Palli 5/A, 43121 Parma, Italy. The application shall be submitted in accordance with the following model. MODEL 1. Information concerning the applicant 1.1. Name and address of the applicant including the name of the natural person responsible for the application and further engagements resulting from this Regulation: 1.2.1. (a) Telephone No: (b) Fax No: (c) E-mail address: 1.2.2. (a) Contact: (b) Alternative: 2. Information to facilitate 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 which should be whenever possible identical or already accepted as equivalent to the one included in Annex I to Directive 91/414/EEC. 2.6. Classification and labelling of the active substance in accordance with the provisions of Regulation (EC) No 1272/2008 of the European Parliament and of the Council of 16 December 2008 on classification, labelling and packaging of substances and mixtures ( 1 ) (health and environment effects). An updating statement, as provided for in Article 5(2), shall be attached as an Annex to the application. The applicant confirms that the above information submitted on … (date) is correct. Signature (of the person competent to act for the applicant referred to under 1.1) ( 1 ) OJ L 353, 31.12.2008, p. 1 .