The document must be completed by the competent authority empowered to issue the permits referred to in Articles 8(2) and 9(6) of Regulation (EU) No 1143/2014. It must be signed, stamped and dated.

Complete the document in capital letters. To indicate positively any option, tick or mark the ☐ sign. Clearly deface or cross out options or whole numbered boxes that are not relevant.

Box 1. Indicate the name, address, country, telephone number and email address of the establishment to which the permit has been granted and/or contact person in this establishment. Box 2. Indicate the identification number of the permit. This number is to start by the two-letter ISO code (ISO 3166 alpha-2) for the Member State issuing the permit, except for Greece and the United Kingdom for which the abbreviations EL and UK is to be used. The identification number is to be unique for the purposes of the permit system referred to in Article 8(1) of Regulation (EU) No 1143/2014. Box 3. Indicate the name, address, country, telephone number and email address of the consignor or exporter, where applicable. Box 4. Indicate the date of issue of the permit. Box 5. Indicate the period of validity (start date; end date) of the permit, where applicable. Box 6. Indicate the name, address, country, telephone number and email address of the consignee or importer, where applicable. Box 7. Indicate the name of the competent authority issuing the permit. Box 8. Describe the consignment or stock of specimens by filling in the information in boxes 8a to 8f: Box 8a. This refers to the scientific name of the invasive alien species of Union concern for which the permit has been issued. Box 8b. This refers to the common name of the invasive alien species for which the permit has been issued. Box 8c. This refers to the codes of Combined Nomenclature (CN) as provided by Council Regulation (EEC) No 2658/87. Box 8d. Precise description of the consignment or stock and the specimens it contains. Box 8e. Total net mass of consignment (or stock) in kg. It may be omitted if information is provided in box 8f. Box 8f. Number of specimens in the consignment. It can be used when the quantity is best expressed in discrete units. It may be omitted if information is provided in box 8e. Box 9. Indicate for which of the restrictions established under Article 7 of Regulation (EU) No 1143/2014 derogation has been granted. Box 10. Indicate the purpose for which the permit has been granted. Box 11. Indicate the relevant sections of the permit describing the conditions under which the activities have been permitted, pursuant to Article 8(2) of Regulation (EU) No 1143/2014. Box 12. Indicate the relevant sections of the permit describing the provisions specified in the authorisation granted by the Commission. To be filled in only if the permit is issued following an authorisation by the Commission under Article 9 of Regulation (EU) No 1143/2014. Box 13. Indicate the name of the authorising officer of the competent authority filling in this document. Box 14. Signature of the authorising officer of the competent authority filling in this document. Box 15. Official stamp of the competent authority and date on which this document was filled in.