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ANNEX

The information sheet referred to in Article 4(1)The information sheet is to be filled in for a single/multiple(1) movement (introduction/translocation) of an alien/locally absent species

1.General information

1.1.Number or reference of the application for a permit:
1.2.First application: YES/NO, if NO: reference of the previous applications for a permit
1.3.
Date of the application for a permit:dd/mm/yyyy
1.4.Data on the species:
1.4.1.FAO code:
1.4.2.Common name:
1.4.3.Scientific name:
1.4.4.Sub-species (if relevant):
1.4.5.Additional information:
1.4.5.1.
Tetraploid:YES/NO
1.4.5.2.
Fertile artificially hybrid:YES/NO
1.4.5.3.If YES, FAO code and name of the parent species:
1.5.Source:
1.5.1.Country:
1.5.2.Location (name and address of the source):
1.5.3.Type of source (hatchery/on-growing farm/wild):
1.6.Receiving aquaculture facility:
1.6.1.Location (name and address):
1.6.2.Method of farming: Closed/Open(2) system
1.7.Number of organisms and life stage (eggs, larvae, juveniles, adults):
1.8.Purpose (human consumption, farming for further restocking, research, etc.):
1.9.Number of movements foreseen:

2.Screening and risk assessment

2.1.Type of movement:
2.1.1.
Routine introduction or translocation:YES/NO
2.1.1.1.
Permit approval:YES/NO
2.1.1.2.
Date of the delivery of the permit:dd/mm/yyyy
2.1.1.3.Authority issuing the permit (complete address):
2.1.1.4.
Duration of the permit:X years XX months
2.1.1.5.If subject to conditions:
2.1.1.5.1.
Quarantine:YES/NO
2.1.1.5.2.
Pilot releases:YES/NO
2.1.2.
Non-routine introduction or translocation:YES/NO
2.1.2.1.Type of risk:
2.1.2.1.1.Low
2.1.2.1.2.Medium
2.1.2.1.3.High
2.1.2.2.Summary report of the overall environment risk assessment (some lines and a PDF document) also in a second Community language (some lines)
2.1.2.3.
Permit approval:YES/NO
2.1.2.4.
Date of the delivery of the permit:dd/mm/yyyy
2.1.2.5.Authority issuing the permit:
2.1.2.6.
Duration of the permit:X years XX months
2.1.2.7.If subject to conditions:
2.1.2.7.1.
Quarantine:YES/NO
2.1.2.7.2.
Pilot releases:YES/NO

3.Monitoring

3.1.
Duration of monitoring programme:XX months
3.2.Summary of the results of the evaluation of the monitoring programme (some lines and a PDF document) also in a second Community language (some lines)
3.3.
Contingency plans applied:YES/NO
3.4.
Withdrawal of the permit (if applicable):YES/NO
3.4.1.If YES: Temporarily/permanently
3.4.2.
Date:dd/mm/yyyy
3.4.3.Reasons for the withdrawal (some lines) also in a second Community language (some lines):
(1)

Applications may be submitted for multiple movements to take place over a period of not longer than seven years (Article 6(1) of Regulation (EC) No 708/2007).

(2)

As defined in Article 3(2) and (3) of Regulation (EC) No 708/2007.