ANNEX ISupplementary provisions
ANNEX I FORM FOR GRANTING OR DENYING WRITTEN CONSENT, PURSUANT TO ARTICLE 4(1) OF REGULATION (EU) 2017/852, TO THE IMPORT OF MERCURY OR OF THE MIXTURES OF MERCURY LISTED IN ANNEX I TO THAT REGULATION FORM FOR GRANTING OR DENYING WRITTEN CONSENT, PURSUANT TO ARTICLE 4(1) OF REGULATION (EU) 2017/852 OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL ON MERCURY, TO THE IMPORT OF MERCURY OR OF THE MIXTURES OF MERCURY LISTED IN ANNEX I TO THAT REGULATION Note: This form applies to the import into the European Union of mercury and of mixtures of mercury with other substances, including alloys of mercury, with a mercury concentration of at least 95 % by weight, as listed in Annex I to Regulation (EU) 2017/852 on mercury (‘mixtures of mercury’). This form does not apply in the case of imports of mercury, or a mixture of mercury that, qualifies as or is considered to be waste within the meaning of Directive 2008/98/EC on waste ( 1 ) . Section A: Contact information to be provided by the importing Member State Name of the designated national focal point ( 2 ) : Address: Tel.: Fax: Email: Section B: Contact information to be provided by the exporting country Name of designated national focal point or responsible government official: Address: Tel.: Fax: Email: Section C: Shipment information to be provided by the exporting country (i) Please indicate the intended total quantity of mercury, whether in pure form or in mixtures, to be shipped (kg) (ii) Please indicate the intended date(s) of shipment(s) (iii) Please indicate if the mercury, whether in pure form or in mixture, is from primary mercury mining: If YES: Exporting country Party to the Minamata Convention: Please indicate if the mercury is from new or from existing primary mining within the meaning of Article 3(3) and (4) of the Minamata Convention. If the exporting country is a non-Party, it has provided certification that the mercury is not from primary mercury mining. (iv) Please confirm that the mercury whether in pure form or in mixture is not from any of the three following sources ( 3 ) : — the chlor-alkali industry (e.g. decommissioning of chlor-alkali cells), — the cleaning of natural gas, — non-ferrous mining and smelting operations. Section D: Information to be provided by the importing Member State What is the purpose of the import of the mercury whether in pure form or in mixtures? Please circle: (i) Environmentally sound interim storage in accordance with Article 7(3) of Regulation (EU) 2017/852 YES NO If yes, please specify the intended use if known. … … … (ii) Use allowed under Union and national legislation ( 4 ) : YES NO If yes, please specify additional details about the intended use of the mercury whether in pure form or in mixture. … … … Section E: Shipping information Importer Name of business: Address: Tel.: Fax: Email: Exporter Name of business: Address: Tel.: Fax: Email: Section F: Indication of consent by the importing Member State Nature of consent, please circle: GRANTED DENIED Please use the space below to indicate any conditions, additional details or relevant information. … … Signature of the importing Member State designated competent authorities and date — Name — Title: — Signature: — Date: ( 1 ) In accordance with Article 4(2) of Regulation (EU) 2017/852, the import into the Union of mixtures of mercury other than those covered by this form and of mercury compounds for the purpose of mercury reclamation is prohibited. ( 2 ) The ‘designated national focal point’ refers to the national focal point designated under Article 17(4) of the Minamata Convention for the exchange of information under the Convention. This is expected to be the same as the ‘competent authority’ designated by the importing Member State under Article 17 of Regulation (EU) 2017/852 as the authority to which import requests under Article 4 should be addressed. ( 3 ) In accordance with Article 11 of Regulation (EU) 2017/852, mercury and mercury compounds, whether in pure form or in mixtures, from any of the three sources listed in the form shall be considered to be waste within the meaning of Directive 2008/98/EC and be disposed of without endangering human health or harming the environment, in accordance with that Directive. ( 4 ) In accordance with Article 4(3) of Regulation (EU) 2017/852, the import into the Union of mercury for use in artisanal and small-scale gold mining is prohibited.