ANNEX

The information sheet referred to in Article 4(1) The information sheet is to be filled in for a single/multiple 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 system
As defined in Article 3(2) and (3) of Regulation (EC) No 708/2007.
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):
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).