ANNEX IVSupplementary provisions
ANNEX IV Text of image EUROPEAN UNION GOODS SUBJECT TO EXPORT CONTROL DRUG PRECURSORS — REGULATION (EC) No 111/2005 IMPORT AUTHORISATION 1 1. Importer (name and address) 2. AUTHORISATION number: Issued (date): at: COPY FOR THE ISSUING AUTHORITY 3. Period of validity: Beginning: End: 4. Exporter (name and address) 5. (For completion by the issuing authority) Issuing Authority (name, address, telephone, fax, e-mail of responsible officer) 6. Other Operator(s) (name and address) 7. Competent authority of the exporting country 8. Ultimate consignee (name and address) 9. Point of entry into the Customs territory of the Union 10. Methods/Means of transport 11a. Scheduled Substance 12a. CN-Code 13a. Net weight 14a. % of mixture 1 15a. Invoice number 11b. Scheduled Substance 12b. CN-Code 13b. Net weight 14b. % of mixture 15b. Invoice number Text of image 16. Declaration by the applicant Name: Representing: (Applicant) Signature: Date: 17. (For completion by issuing authority) Boxes 7, 9, 10 still required: YES /NO Signature: Function: Date: Stamp: 18. (For completion by the customs office in the Union) Customs reference (declaration of entry into the procedure or reference number to the custom approved treatment or use) Signature of officer: Function: Place: Date: Stamp: Text of image EUROPEAN UNION GOODS SUBJECT TO EXPORT CONTROL DRUG PRECURSORS — REGULATION (EC) No 111/2005 IMPORT AUTHORISATION 2 1. Importer (name and address) 2. AUTHORISATION number: Issued (date): at: COPY FOR THE AUTHORITY IN THE COUNTRY OF EXPORT 3. Period of validity: Beginning: End: 4. Exporter (name and address) 5. (For completion by the issuing authority) Issuing Authority (name, address, telephone, fax, e-mail of responsible officer) 6. Other Operator(s) (name and address) 7. Competent authority of the exporting country 8. Ultimate consignee (name and address) 9. Point of entry into the Customs territory of the Union 10. Methods/Means of transport 11a. Scheduled Substance 12a. CN-Code 13a. Net weight 14a. % of mixture 2 15a. Invoice number 11b. Scheduled Substance 12b. CN-Code 13b. Net weight 14b. % of mixture 15b. Invoice number 16. Declaration by the applicant) Name: Representing: (Applicant) Signature: Date: Text of image 17. (For completion by issuing authority) Boxes 7, 9, 10 still required: YES /NO Signature: Function: Date: Stamp: 18. (For completion by the customs office in the Union) Customs Reference (declaration of entry into the procedure or reference number to the custom approved treatment or use) Signature of officer: Function: Place: Date: Stamp: Text of image EUROPEAN UNION GOODS SUBJECT TO EXPORT CONTROL DRUG PRECURSORS — REGULATION (EC) No 111/2005 IMPORT AUTHORISATION 3 1. Importer (name and address) 2. AUTHORISATION number: Issued (date): at: COPY TO ACCOMPANY THE GOODS 3. Period of validity: Beginning: End: 4. Exporter (name and address) 5. (For completion by the issuing authority) Issuing Authority (name, address, telephone, fax, e-mail of responsible officer) 6. Other Operator(s) (name and address) 7. Competent authority of the exporting country 8. Ultimate consignee (name and address) 9. Point of entry into the Customs territory of the Union 10. Methods/Means of transport 11a. Scheduled Substance 12a. CN-Code 13a. Net weight 14a. % of mixture 3 15a. Invoice number 11b. Scheduled Substance 12b. CN-Code 13b. Net weight 14b. % of mixture 15b. Invoice number 16. Declaration by the applicant) Name: Representing: (Applicant) Signature: Date: Text of image 17. (For completion by issuing authority) Boxes 7, 9, 10 still required: YES /NO Signature: Function: Date: Stamp: 18. (For completion by the customs office in the Union) Customs Reference (declaration of entry into the procedure or reference number to the custom approved treatment or use) Signature of officer: Function: Place: Date: Stamp: Text of image EUROPEAN UNION GOODS SUBJECT TO EXPORT CONTROL DRUG PRECURSORS — REGULATION (EC) No 111/2005 IMPORT AUTHORISATION 4 1. Importer (name and address) 2. AUTHORISATION number: Issued (date): at: COPY FOR THE IMPORTER 3. Period of validity: Beginning: End: 4. Exporter (name and address) 5. (For completion by the issuing authority) Issuing Authority (name, address, telephone, fax, e-mail of responsible officer) 6. Other Operator(s) (name and address) 7. Competent authority of the exporting country 8. Ultimate consignee (name and address) 9. Point of entry into the Customs territory of the Union 10. Methods/Means of transport 11a. Scheduled Substance 12a. CN-Code 13a. Net weight 14a. % of mixture 4 15a. Invoice number 11b. Scheduled Substance 12b. CN-Code 13b. Net weight 14b. % of mixture 15b. Invoice number 16. Declaration by the applicant) Name: Representing: (Applicant) Signature: Date: Text of image 17. (For completion by issuing authority) Boxes 7, 9, 10 still required: YES /NO Signature: Function: Date: Stamp: 18. (For completion by the customs office in the Union) Customs Reference (declaration of entry into the procedure or reference number to the custom approved treatment or use) Signature of officer: Function: Place: Date: Stamp: Notes 1. The authorisation shall be completed in one of the official languages of the Union. If it is hand-written, it shall be completed in ink in capital letters. 2. Boxes 1, 4, 6, 8 and 11 to 16 are to be provided by the applicant at the time of the request; however, information as required in boxes 7, 9, 10 and 15 may be supplied at a later stage. In this case, this information is to be supplemented at the latest when the goods are entered into the customs territory of the Union. 3. Boxes 1, 4: Enter full names and addresses (phone, fax, e-mail). 4. Box 6: Enter full name and address (phone, fax, e-mail) of any other operator involved in the import operation such as transporters, intermediaries, customs agents. 5. Box 8: Enter full name and address of the ultimate consignee. The ultimate consignee may be identical with the importer. 6. Box 7: Enter name and address (phone, fax, e-mail) of the third country authority. 7. Box 9: Give the name of the Member State and the port, airport or border point. 8. Box 10: Specify all means of transport to be used (e.g. lorry, ship, plane, train, etc.). 9. Boxes 11a, 11b: Enter name of the scheduled substance as stated in the Annex to Regulation (EC) No 111/2005, the commercial name of the medicinal product listed in Category 4, the number of units in the consignment, the number of tablets/ampoules in each unit, the content of the scheduled substance in a single unit (per tablet/ampoule) or in the case of a mixture or natural product enter the name and the 8 digit CN code, as well as the commercial name 10. Boxes 11a, 11b: Identify packages and substances with precision (e.g. 2 cans of 5 litres each). In the case of a mixture, a natural product or preparations, indicate the commercial name concerned. 11. Boxes 12a, 12b: Enter the 8 digit CN code of the scheduled substance as stated in the Annex of Regulation (EC) No 111/2005. Box 13 a, 13b: for Category 4, enter the total net weight of the scheduled substance contained in the consignment of medicinal products. 12. Box 16: — Indicate in block letters the name of the applicant or, where appropriate, of his authorised representative who signs this application. — The signature by the applicant or his authorised representative, according to the modalities provided for by the Member State concerned, indicates that the person concerned is declaring that all the particulars provided on the application are correctly and fully stated. Without prejudice to the possible application of penal provisions, this declaration is equivalent to the engagement of responsibility, under the provisions in force in the Member States, in respect of the following: — the accuracy of the information; — the authenticity of any documents attached; — the observance of all other obligations. — Whenever the authorisation is issued by means of a computerised procedure, that authorisation may not contain the signature of the applicant in this box, if the application as such contains such signature. 13. Personal data protection Where the European Commission processes personal data contained in this document, Regulation (EC) No 45/2001 of the European Parliament and of the Council on the protection of individuals with regard to the processing of personal data by the Community Institutions and bodies and on the free movement of such data will apply. Where the competent authority of a Member State processes personal data contained in this document, the national provisions implementing Directive 95/46/EC will apply. The purpose of the processing of personal data is the monitoring of trade in drug precursors within the Union in accordance to Regulation (EC) No 273/2004 as amended by Regulation (EU) No 1258/2013, and between the Union and third countries in accordance with Regulation (EC) No 111/2005, as amended by Regulation (EU) No 1259/2013. The controller with respect to the processing of the data is the national competent authority where the present document has been submitted. The list of competent authorities is published on the website of the Commission: http://ec.europa.eu/taxation_customs/resources/documents/customs/customs_controls/drugs_precursors/legislation/national_competent_authorities.pdf In accordance with Article 17 of Regulation (EC) No 111/2005 laying down rules for the monitoring of trade in drug precursors between the Union and third countries, without prejudice to applicable provisions on data protection in the Union and for the purpose of controlling and monitoring certain substances frequently used for the illicit manufacture of narcotic drugs or psychotropic substances, the Commission and the competent authorities of the Member States may share personal data and information contained in the present document with the relevant authorities in third countries. The data subject has a right of access to the personal data relating to him or her that will be processed and, where appropriate, the right to rectify erase or block personal data in accordance with Regulation (EC) No 45/2001 or the national laws implementing Directive 95/46/EC. All requests for the exercise of the right of access, rectification, erasure or blocking shall be submitted to and processed by the competent authorities where the present document was submitted. The legal basis for processing the personal data is Article 33 of Regulation (EC) No 111/2005 and Article 13b of Regulation (EC) No 273/2004. Personal data contained in the present document shall not be retained longer than necessary for the purposes for which it was collected. Complaints, in case of conflict, can be addressed to the relevant national data protection authority. The contact details of the national data protection authorities are available on the web-site of the European Commission, Directorate-General for Justice: (http://ec.europa.eu/justice/data-protection/bodies/authorities/eu/index_en.htm#h2-1) Where the complaint concerns processing of personal data by the European Commission, it should be addressed to the European Data Protection Supervisor: (http://www.edps.europa.eu/EDPSWEB/).