Application for Assessment Certificate PLC notification申请评估证书通知.docVIP

Application for Assessment Certificate Polymer of Low Concern (PLC) FORM PLC-1 Application for Assessment Certificate Use this form to apply for an Assessment Certificate for a Polymer of Low Concern (PLC) under section 24A of the Industrial Chemicals (Notification and Assessment) Act 1989. Instructions for Completing form PLC-1 PART 1 Applicant(s) details and declaration is essential information that must be completed. For joint notifications each applicant must at least complete and sign a separate Part 1. PART 2 The PLC template requires the applicant to provide information to NICNAS about the chemical in a standardised format. When third party information is being provided only the holder of the confidential data need complete the sections where this information is required. The third party providing the information should also complete a Third Party Information Lodgement (Form 5). PART 3 The notification Checklist is a guide to the information required to support an application for an Assessment Certificate under the Polymer of Low Concern category. NOTE - INCOMPLETE FORMS WILL LEAD TO DELAYS IN PROCESSING OF APPLICATIONS. Notification Statement Applicant(s) to complete. Click in the boxes, or write in the space provided. This notification statement contains: A completed electronic copy of Form PLC-1. Two hardcopies of the completed Form PLC-1 with at least one signed and dated by the applicant(s). Test reports, chemical structure, spectra and other relevant information in duplicate. Notification Fee - See the ‘Payment advice’ section below for further information. When required the Modular Attachment Form and the Form 5 should also be provided. Send Notification Statement to: Director NICNAS Level 7, 260 Elizabeth Street Surry Hills NSW 2010 GPO Box 58, Sydney NSW 2001 Telephone (02) 8577 8800 / 1800 638 528 Fax (02) 8577 8888 PART 1: APPLICANT AND APPLICATION DETAILS Joint Application YES NO If yes, number of applicants?: (E