Check your answers before sending your application

• Date received: Change
• Signed: Change
• Reference: Change
• Official - Sensitive - Commercial (once completed by the applicant): Change
• 1.1 Company name: Change
• 1.2 Employee or consultant name: Change
• 1.3 Address of company, including postcode: Change
• Address of manufacturing site, including postcode (if different to the address of company): Change
• Telephone number (including international dialling code, if applicable): Change
• Email address: Change
• Company's VAT number: Change
• Parent product name: Change
• Physical form in which the disinfectant is to be tested and sold: Change
• Batch number of the disinfectant sample: Change
• Date the sample was manufactured: Change
• Expiry date of the disinfectant sample: Change
• 2.6 Storage instructions: Change
• 2.7 Directions for use: Change
• 2.8 Proposed use: Change
• 2.9 Product composition: Change
• 2.10 I confirm the substances listed in the above table total 100% Signed: Change
• 2.11 Have you submitted any additional information with this application? Type yes or no: Change
• 3.1 Tests to order: Change
• Official - Sensitive - Commercial (once completed by the applicant) single dilution Poultry diseases, avian influenza and influenza of avian origin in mammals: triple dilution Tuberculosis disease: single dilution Tuberculosis disease: triple dilution Other notifiable disease requirements: single dilution Other notifiable disease requirements: triple dilution: Change
• 3.2 Total cost, including the administrative fee State the total cost for all tests you are applying for, in pounds sterling. Include the administrative fee for new tests.: Change
• 4.1 Proposed new trade name: Change
• (vii) Section 4: Trade name approval (back-to-back approved trade names): Change
• Distributor company name: Change
• Distributor company address (including postcode): Change
• Distributor company representative's name: Change
• Distributor company representative's email: Change
• Distributor company representative's telephone number: Change
• Distributor company representative's signature: Change
• Date of signature: Change
• Have you supplied any additional information with this application?: Change
• 5.1 Company name: Change
• 5.2 Applicant's name: Change
• 5.3 Date of application: Change
• 5.4 Applicant's signature: Change
• Official - Sensitive - Commercial (once completed by the applicant) If a disinfectant you manufacture or distribute is approved by Defra, the name and address you provide will be publicly available on the approved disinfectants list.: Change
• (x) Labels: Change
• Delivery address: Change
• Disinfectant Name: Change
• Batch Number: Change
• Expiry Date: Change
• Contents (sample volume): Change
• MSDS enclosed (tick): Change
• Compliant with CLP Regulations (tick): Change
• Signed: Change
• Disinfectant Name: Change
• Batch Number: Change
• Sender: Change
• Company Name: Change
• Contents: samples (tick to confirm tests required and sample volumes enclosed): Change
• FMDV: Change
• SVDV: Change
• DoP: Change
• TB: Change
• GO: Change
• MSDS enclosed (tick): Change
• Signed: Change

Now send your application

By submitting this application you are confirming that, to the best of your knowledge, the details you are providing are correct.