FORM-1
Application
For Registration of pesticides
Control of Pesticides Act, No.33 of 1980
Sri Lanka
Please refer the Guideline before compilation of the application.
1. GENERAL
(Details pertaining to this section should be furnished in the spaces given against the respective Items)
1.1 Name of the registrant:
1.2 Name and designation of the authorised signatory:
1.3 Address:
1.3.1 Office:
1.3.2 Warehouse/ Factory:
1.4 T/Phone No: Fax No: E-mail:
2. PRODUCT DETAILS
(Details pertaining to this section should be furnished in the spaces given against the respective Items)
2.1 Trade name:
2.2 Use category: INSECTICIDE/FUNGICIDE/WEEDICIDE/OTHER (delete the sections not
relevant)
2.2.1 If other, please specify:
2.3 Intended user/market
2.4 Use classification: AGRICULTURAL/DOMESTIC/INDUSTRIAL/PUBLIC HEALTH/
VERINARY/WAREHOUSE/FORMULATION PURPOSES//OTHER (delete the sections not
relevant)
2.4.1 If other, please specify:
2.5 Common name(s) of active ingredient(s):
2.6 Strength of formulation:
2.7 Type of formulation:
2.8 Type of containers:
2.9 Size of containers:
2.10 Registration in other countries:
2.10.1. Registration in the country of origin (copies of registration certificates should
be authenticated as per the Guideline):
2.10.2. Other countries where registered (copies of registration certificate should be
authenticated as per the Guideline):
2.11 Do you already hold a valid registration for the proposed formulation or applied for
registration from an alternate source. YES/NO
If “YES”: Application No: Registration No:
3. SOURCE
(Details pertaining to this section should be furnished in the spaces given against the respective Items)
Item 3 .1 Item 3.2 Item 3.3
Manufacturer Formulator Supplier
Company Name
Contact Name
Contact Title
Address
City
Postal Code
State/Province
Country
T/Phone Number
Fax Number
E-mail Address
3.4 Declaration of the manufacturer of the technical material is attached: YES / NO
3.5 Declaration of the formulator of the pesticide is attached: YES / NO
4. ACTIVE INGREDIENT
(Details pertaining to this section should be furnished in separate documents. Indicate respective number(s) of the
annexed documents against relevant Items below. Please see section ‘D’ in the Guideline)
4.1 Summary of chemical and physical properties
4.2 Data on environmental behaviour
4.3 Bio-toxicological effects
4.4 Source(s) of reference
5. TECHNICAL MATERIAL
(Details pertaining to this section should be furnished in separate documents. Indicate respective number(s) of the
annexed documents against relevant Items below. Please see section ‘D’ in the Guideline)
5.1 Summary of chemical and physical properties:
5.2 Detailed composition
5.3 Method of analysis
5.4 Shelf-life
5.5 Toxicological data
5.6 Summary of residue data
5.7 Method of residue analysis
6. FORMULATION
(Details pertaining to this section should be furnished in separate documents. Indicate respective number(s) of the
annexed documents against relevant Items below. Please see section ‘D’ in the Guideline)
6.1 Summary of chemical and physical properties
6.2 Specific detailed composition
6.3 Method of analysis
6.4 Shelf-life
6.5 Toxicological data
6.6 Summary of bio-efficacy data
7. ADDITIONAL SUBMISSIONS
7.1 Specimen labels prepared in accordance with the Section 8 of the Act, in duplicate
7.2 Specimen containers
7.3 Specimen samples of
7.3.1 Reference standard (active ingredient(s) and any toxic impurities/isomers, if
present (1 g or 1 ml)
7.3.2 Technical grade material (from the source declared above) (50 g or 50 ml)
7.3.3 Formulation (from the source declared above) (100 g or 100 ml)
7.3.3.1 Aerosols (2X100 ml or more)
7.3.3.2 Mosquito Coils (5X10 pieces)
7.3.3.3 Mosquito Mats (3X30 pieces)
7.3.3.4 Others (Refer to Pesticide Registration Authority)
7.4 Non refundable payment a sum of Rs.6500.00 as filing fee (Cheques must be drawn in
favour of the Director General of Agriculture. Money-orders must be payable at the Post Office-
Peradeniya.)
I hereby solemnly declare and affirm that all information given by me is true and correct.
………….............................
Signature, name & designation Date:
Notes:
1.Applications will not be accepted if sections 1,2,3 and 7 are incomplete. Authority may waive details of certain
technical data requirements of the Sections 4,5 and 6 or accept applications lack any of those details for evaluation
on the basis that it may not increase any potential adverse effect on human health and the environment.
2.The decision of registration of the pesticide is based on the submission of document along with the registration
application on the assumption that they are final and accurate declarations for that purpose. Therefore,
administrative or other legal actions would not be reviewed on the grounds that those declarations contained
incorrect information by an oversight or typing mistake unless the reports pertaining to such claims are verified at
the expense of the applicant through independent sources decided by the Registration Authority. However, the
Registrant may propose amendments or alterations to their submissions if they find the claims need to be updated
based on subsequent field observations, published reports with proof or proprietary data by the patent holder.
3.Upon acceptance of the application for registration, a sum of Rs.4,000.00 (A cheque drawn in favour of the
Director General of Agriculture or a Money-order payable at Post Office- Peradeniya shall be submitted as
registration fee.)
Office use only
Application No: Date received:
Registration No: Date Registered:
Application accepted/returned:
Reasons for the return:
l Incomplete application. (items: …………………………)
l Technical documents are not numbered
l Relevant references are not indicated in the applicatio
l Technical documents are not in duplicate
