Schedule
FORM A – 1
(Regulation 3)
APPLICATION FOR APPROVAL OF PESTICIDE
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The Secretary,
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Pesticides Control Board,
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Ministry of Agriculture,
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Castries
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Dear Sir/Madam,
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I ............................................................................................... (Name)
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of ............................................................................................ (Address)
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hereby apply to the Pesticides Control Board for approval of the pesticide ..................
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.......................................................................................... (Trade Name)
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1. Name of manufacturer ............................................................................
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...........................................................................................................
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2. Common names of all active ingredients and their percentage content and the percentages and types of the remaining ingredients for the pesticide
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...........................................................................................................
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...........................................................................................................
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3. Type of formulation. (Specify whether the pesticide is an emulsifiable, concentrate, wettable powder, dust, granule or has any other physical form). (Please use this form for one type of formulation only).
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...........................................................................................................
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4. Crops and types of pests for which pesticides are to be used
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...........................................................................................................
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...........................................................................................................
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...........................................................................................................
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5. Manufacturers recommended method, frequency and rate of application
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...........................................................................................................
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6. First aid measurers to be taken pending medical advice in a case of suspected poisoning by the pesticide and the treatment that should be administered by a medical practitioner. Specify recommended antidotes
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...........................................................................................................
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...........................................................................................................
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7. The toxic effects likely to be caused in persons using or handling the pesticide with special reference to the toxic effects likely to be caused by indigestion, by inhalation and by absorption through the skin
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............................................................................................................
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............................................................................................................
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8.
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(a) Recommended period between final application and harvest (with supporting data)
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............................................................................................
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............................................................................................
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(b) Information on the levels of residues in food likely to result from use recommended rates, timing, frequency and methods of application
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............................................................................................
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9. The toxic effects which the use of the pesticide may have on birds, fishes, bees, biological agents and on other wild-life and domestic animals
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...........................................................................................................
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...........................................................................................................
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10. LD 50 pesticide. State tested animals—
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Oral ..............................................................................................
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Dermal .........................................................................................
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Inhalation ......................................................................................
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11. Methods for formulation analysis of the pesticides and for analysis of their residues in crops, animals, produce and animals products. (Note: Reference to published methods of analysis will be acceptable.)
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...........................................................................................................
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...........................................................................................................
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12. Tolerance levels as prescribed by FAO/WHO
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...........................................................................................................
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13. Other information (usage etc.)
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...........................................................................................................
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FORM A – 2
(Regulation 4)
APPLICATION FOR A LICENCE TO IMPORT/MANUFACTURE A PESTICIDE
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The Secretary,
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Pesticides Control Board,
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Ministry of Agriculture,
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Castries,
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Saint Lucia, W.I.
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Date ..............
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Sir/Madam,
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(Name) ..................................................................................................
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of (Address) ..................................................... hereby apply to the Pesticide Control Board for a licence to Import/Manufacture (state quantity) ........................ of the pesticide .............................................................. containing the active ingredients(s) .............................. in the formulation .....................................
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................................................
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Applicant
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This application must be accompanied by—
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(a) a copy of all labels or of all proposed labels used or intended to be used on the container in which the pesticide is to be packed;
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(b) a copy of any instructions or of any proposed instruction accompanying or intended to accompany each package of the pesticide;
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(c) a statement setting out any information, additional to that given on the label and additional to that contained in the instructions accompanying the package relating to the safety precautions and the type of clothes, facilities and equipment recommended to prevent hazards to persons using or handling the pesticide;
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(d) documented evidence that the pesticide is being sold for use in its country of origin and whether there are any conditions attached to such use; and
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(e) all booklets and documents in which information is given and make reference to them on the form.
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Note: The Board reserves the right to revoke approval of the pesticide (the licence) at any time during the approved period if it deems this necessary.
FORM A – 3
(Regulations 6 and 7)
PERMIT/LICENCE TO IMPORT/MANUFACTURE A PESTICIDE
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Licence No ......................
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Date of Issue .....................
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Date of expiry ...................
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The Licensee ...........................................................................................
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of .........................................................................................................
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is hereby permitted to import/manufacture .......................................................
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quantity of ............................................................................. containing the
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active ingredient(s) ....................................................................................
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............................................................................................................
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in the formulation .....................................................................................
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............................................................................................................
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............................................................................................................
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Subject to the following conditions .................................................................
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...........................................................................................................
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............................................
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Secretary, Pesticides Control Board
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Please note the following—
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1. Each package sold or distributed must be accompanied by a copy of those conditions which relate to the use and storage of this pesticide.
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2. Any change in the trade name of the pesticide, or in the name and address of the person to whom this licence is issued, must be communicated to the Pesticides Control Board within one month of the change.
FORM B – 1
(Regulation 8)
APPLICATION FOR APPROVAL OF PREMISES TO DEAL WITH PESTICIDES
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Date ..............................
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The Secretary,
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Pesticides Control Board,
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Ministry of Agriculture,
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Castries,
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Saint Lucia, W.I.
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Dear Sir/Madam,
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I................................................................................................. (Name)
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of .........................................................................................................
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.................................................................................................... hereby
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apply to the Pesticides Control Board for Licensing of my premises at—
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1. ...................................................................................... for warehousing
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2. ..................................................................................... for repackaging
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3. ......................................................................... for retailing of pesticides.
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I have complied with all the provisions of the Employees (Occupational Health and Safety) Act relating to the premises.
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.........................................
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Applicant
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N.B. Applicants may be requested to provide additional information by the Board.
FORM B – 2
(Regulation 9)
NOTICE
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The Pesticides Control Board,
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Ministry of Agriculture,
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Castries,
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Saint Lucia, W.I.
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Date ...............................
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Dear Sir/Madam,
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The Board has met to consider your application dated ......................................
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for licensing of your premises at—
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1. ..................................................................................... for warehousing
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2. .................................................................................... for repackaging
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3. ........................................................................ for retailing of pesticides.
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An Inspector will be visiting your premises on ..................................................
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................................................. at .......................................................
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Your co-operation will be appreciated.
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Yours faithfully,
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........................................
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Secretary,
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Pesticides Control Board
FORM B – 3
(Regulation 9)
NOTICE
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The Pesticides Control Board,
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Ministry of Agriculture,
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Castries,
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Saint Lucia, W.I.
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Date ...............................
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Dear Sir/Madam,
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The Board considered your application dated ................................................
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................................................................for licensing of your premises at—
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1. ...................................................................................... for warehousing
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2. ..................................................................................... for repackaging
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3. ........................................................... for retailing of pesticides, and upon investigation decided to approve/not to approve your premises licensed, for a period of
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Yours faithfully,
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........................................
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Secretary,
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Pesticides Control Board
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Reasons for not approving—
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..........................................................................................................
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..........................................................................................................
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..........................................................................................................
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FORM C
(Regulation 11)
PURCHASE OF A RESTRICTED PESTICIDE
(Poison)
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I ........................................................................................... (Full Name)
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Of ............................................................................................ (Address)
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...........................................................................................................
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Have this day purchased ..................................................................... (Quantity)
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Of restricted pesticide ............................................................... (Trade Name)
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(..........................................% active ingredient ........................................)
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knowing that this is a very poisonous substance.
Signed:...................................................
Date:......................................................
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Witnessed by dealer:............................................. Dealer's stamp
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Proof of identity — I.D. Card No.
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Passport No.........................
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Original — Pesticides Board
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Duplicate — Purchaser
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Triplicate — Dealer