European Community

Licence

(Article 3(2) of Regulation (EC) No 273/2004)

(Article 6(1) of Regulation (EC) No 111/2005)

MS:

(Licence Number)

ORIGINAL

1. Licence holder (name, address, phone, fax, e-mail)

2. Issuing authority

1a. Additional information

1b. Additional information

3. Validity

Beginning:

End:

4. The licence covers the following:

Scheduled substance(s)

CN Code

Operation

Business premises

5. Additional information/conditions

6. Date Signature Stamp Name

European Community Declaration of the operator on the entry of the scheduled substances into the Community customs territory (Article 8 of Regulation (EC) No 111/2005)

Article 12 of the United Nations’ Convention against illicit traffic in narcotic drugs and psychotropic substances

ORIGINAL

1. Operator (name, address, phone, fax, e-mail)

2a. Country of export

2b. Transit country/countries

2c. Country of final destination

3a. Exporter in the country of export (name, address, phone, fax, e-mail)

3b. Competent authority in country of export (name, address, phone, fax, e-mail)

4a. Importer in the country of destination (name, address, phone, fax, e-mail)

4b. Competent authority in the country import (name, address, phone, fax, e-mail)

5a. Scheduled Substance

5a. CN Code

5a. Net weight

5a. % of mixture

5b. Scheduled Substance

5b. CN Code

5b. Net weight

5b. % of mixture

6a. Bill of lading/Airway bill/or other transport document number of country of export

6b. Reference number of the export authorisation of the exporter in the third country of export (optional)

7. Declaration by the Operator:

Name:

Representing:

(Operator)

I hereby declare that — to my knowledge — the scheduled substances have left the country of export in accordance with the provisions in force adopted pursuant to Article 12 of the United Nations’ Convention against illicit traffic in narcotic drugs and psychotropic substances. The following supporting evidence is attached (optional):

copy of export authorisation copy of licence/registration

Signature: Place: Date:

MULTILATERAL CHEMICAL REPORTING NOTIFICATION

1. ACTION ADDRESSEE

2. Additional addressee

3. Additional addressee

4. Name

5. Agency (name and address)

6. Country

7. Telephone

8. Fax

9. E-mail

10. Signature and date

11. This shipment WILL WILL NOT proceed if a reply is not received within … days.

12. Does your office have any objection to this shipment? Yes No Further inquiries required If YES, please provide details and reasons.

PART A

This multilateral chemical reporting notification covers:

one export operation, or

several export operations to be carried out within a specific time frame (Beginning: End: ).

13. Name of scheduled substance

14. Quantity and weight

15. CN code

16. Exporting country

17. Point of exit

18. Departure date

19. Importing country

20. Point of entry

21. Estimated arrival date

22. Transhipment route (including Free Zones, and Final Destination)

23. Means of transport:

24. Importer (name, address, telephone and fax)

25. Import/export authorisation number

26. Ultimate consignee (name, address, telephone and fax)

27. Other remarks

PART B

32. Exporter, manufacturer or supplier (name, address, telephone and fax)

33. Intermediaries (name, address, telephone and fax)

34. Transit companies (name, address, telephone and fax)

35. Transportation details (Flight No/vessel, etc.)

EUROPEAN COMMUNITY

GOODS SUBJECT TO EXPORT CONTROL

DRUG PRECURSORS — REGULATION (EC) No 111/2005 EXPORT AUTHORISATION

1

1. Exporter (name and address)

2. AUTHORISATION number:

COPY FOR THE ISSUING AUTHORITY

Issued (date): at:

3. Simplified export authorisation procedure YES /NO

4. Period of validity:

Beginning: End:

5. Importer in the country of destination (name and address)

Import authorisation No

6. (For completion by the issuing authority) Issuing Authority (name, address, phone, fax, e-mail)

7. Other Operator(s) (name and address)

8. Customs office where the customs declaration will be made (name and address)

9. Ultimate consignee (name and address)

10. Point of exit

11. Point of entry into the importing country

12. Means of transport

13. Itinerary

14a. Scheduled substance

15a. CN code

16a. Net weight

17a. % of mixture

1

18a. Invoice number

14b. Scheduled substance

15b. CN code

16b. Net weight

17b. % of mixture

18b. Invoice number

19. Declaration by the applicant Name:

Representing: (Applicant)

Signature: Date:

20. (For completion by the customs office where the export declaration is made unless the simplified export authorisation procedure is applied)

Reference number of customs declaration:

Stamp:

21. (For completion by issuing authority unless the simplified export authorisation procedure is applied) Box 18 information still required: YES /NO Boxes 7, 8, 10-13 information still required YES /NO Signature: Function: Date: Stamp:

22. CONFIRMATION OF EXIT FROM THE EC (For completion by the competent authorities at the point of exit from the Community customs territory unless the simplified export authorisation procedure is applied) Date of exit: Signature of officer: Function: Place: Date: Stamp:

EUROPEAN COMMUNITY

GOODS SUBJECT TO EXPORT CONTROL

DRUG PRECURSORS — REGULATION (EC) No 111/2005 EXPORT AUTHORISATION

2

1. Exporter (name and address)

2. AUTHORISATION number:

COPY TO ACCOMPANY THE GOODS TO POINT OF EXIT (*)

Issued (date): at:

3. Simplified export authorisation procedure YES /NO

4. Period of validity:

Beginning: End:

5. Importer in the country of destination (name and address)

Import authorisation No

6. (For completion by the issuing authority) Issuing Authority (name, address, phone, fax, e-mail)

7. Other Operator(s) (name and address)

8. Customs office where the customs declaration will be made (name and address)

9. Ultimate consignee (name and address)

10. Point of exit

11. Point of entry into the importing country

12. Means of transport

13. Itinerary

14a. Scheduled substance

15a. CN code

16a. Net weight

17a. % of mixture

2

18a. Invoice number

14b. Scheduled substance

15b. CN code

16b. Net weight

17b. % of mixture

18b. Invoice number

19. Declaration by the applicant Name:

Representing: (Applicant)

Signature: Date:

20. (For completion by the customs office where the export declaration is made unless the simplified export authorisation procedure is applied)

Reference number of customs declaration:

Stamp:

21. (For completion by issuing authority unless the simplified export authorisation procedure is applied)

Box 18 information still required: YES /NO

Boxes 7, 8, 10-13 information still required YES /NO

Signature:

Function:

Date: Stamp:

22. CONFIRMATION OF EXIT FROM THE EC

(For completion by the competent authorities at the point of exit from the Community customs territory unless the simplified export authorisation procedure is applied)

Date of exit:

Signature of officer:

Function: Place:

Date: Stamp:

(*) Unless the simplified export authorisation procedure is used.

Simplified export authorisation procedure

23. Net weight

26. Customs declarations (reference number and date)

27. (For completion by the customs office where the customs declaration is made)

Member State, name and address of the customs office, date, stamp and signature of the officer.

24. Available quantity (1) and partial export quantity (2)

25. Partial export quantity in words

1

2

1

2

1

2

1

2

1

2

1

2

1

2

1

2

1

2

1

2

1

2

EUROPEAN COMMUNITY

GOODS SUBJECT TO EXPORT CONTROL

DRUG PRECURSORS — REGULATION (EC) No 111/2005 EXPORT AUTHORISATION

3

1. Exporter (name and address)

2. Authorisation number:

COPY TO ACCOMPANY THE GOODS TO IMPORTING COUNTRY

Issued (date): at:

3. Simplified export authorisation procedure YES /NO

4. Period of validity:

Beginning: End:

5. Importer in the country of destination (name and address)

Import authorisation No

6. (For completion by the issuing authority) Issuing Authority (name, address, phone, fax, e-mail)

7. Other Operator(s) (name and address)

8. Customs office where the customs declaration will be made (name and address)

9. Ultimate consignee (name and address)

10. Point of exit

11. Point of entry into the importing country

12. Means of transport

13. Itinerary

14a. Scheduled substance

15a. CN code

16a. Net weight

17a. % of mixture

3

18a. Invoice number

14b. Scheduled substance

15b. CN code

16b. Net weight

17b. % of mixture

18b. Invoice number

19. Declaration by the applicant Name:

Representing: (Applicant)

Signature: Date:

20. (For completion by the customs office where the export declaration is made unless the simplified export authorisation procedure is applied)

Reference number of customs declaration:

Stamp:

21. (For completion by issuing authority unless the simplified export authorisation procedure is applied)

Box 18 information still required: YES /NO

Boxes 7, 8, 10-13 information still required YES /NO

Signature:

Function:

Date: Stamp:

22. CONFIRMATION OF EXIT FROM THE EC

(For completion by the competent authorities at the point of exit from the Community customs territory unless the simplified export authorisation procedure is applied)

Date of exit:

Signature of officer:

Function: Place:

Date: Stamp:

EUROPEAN COMMUNITY

GOODS SUBJECT TO EXPORT CONTROL

DRUG PRECURSORS — REGULATION (EC) No 111/2005 EXPORT AUTHORISATION

4

1. Exporter (name and address)

2. AUTHORISATION number:

COPY FOR THE EXPORTER

Issued (date): at:

3. Simplified export authorisation procedure YES /NO

4. Period of validity:

Beginning: End:

5. Importer in the country of destination (name and address)

Import authorisation No

6. (For completion by the issuing authority) Issuing Authority (name, address, phone, fax, e-mail)

7. Other Operator(s) (name and address)

8. Customs office where the customs declaration will be made (name and address)

9. Ultimate consignee (name and address)

10. Point of exit

11. Point of entry into the importing country

12. Means of transport

13. Itinerary

14a. Scheduled substance

15a. CN code

16a. Net weight

17a. % of mixture

4

18a. Invoice number

14b. Scheduled substance

15b. CN code

16b. Net weight

17b. % of mixture

18b. Invoice number

19. Declaration by the applicant Name:

Representing: (Applicant)

Signature: Date:

20. (For completion by the customs office where the export declaration is made unless the simplified export authorisation procedure is applied)

Reference number of customs declaration:

Stamp:

21. (For completion by issuing authority unless the simplified export authorisation procedure is applied)

Box 18 information still required: YES /NO

Boxes 7, 8, 10-13 information still required YES /NO

Signature:

Function:

Date: Stamp:

22. CONFIRMATION OF EXIT FROM THE EC

(For completion by the competent authorities at the point of exit from the Community customs territory unless the simplified export authorisation procedure is applied)

Date of exit:

Signature of officer:

Function: Place:

Date: Stamp:

EUROPEAN COMMUNITY

GOODS SUBJECT TO IMPORT CONTROL

DRUG PRECURSORS — REGULATION (EC) No 111/2005 IMPORT AUTHORISATION

1

1. Importer (name and address)

2. AUTHORISATION number:

COPY FOR THE ISSUING AUTHORITY

Issued (date): at:

3. Period of validity:

Beginning: End:

4. Exporter (name and address)

5. (For completion by the issuing authority) Issuing Authority

(name, address, telephone, fax, e-mail of responsible officer)

6. Other Operator(s) (name and address)

7. Competent authority of the exporting country

8. Ultimate consignee (name and address)

9. Point of entry into the Community Customs territory

10. Methods/Means of transport

11a. Scheduled substance

12a. CN code

13a. Net weight

14a. % of mixture

1

15a. Invoice number

11b. Scheduled substance

12b. CN code

13b. Net weight

14b. % of mixture

15b. Invoice number

16. Declaration by the applicant Name: Representing: (Applicant)

Signature: Date:

17. (For completion by issuing authority)

Boxes 7, 9, 10 still required YES /NO

Signature:

Function:

Date: Stamp:

18. (For completion by the customs office in the Community)

Customs reference

(declaration of entry into the procedure or reference number to the customs approved treatment or use)

Signature of officer:

Function:

Place: Date: Stamp:

EUROPEAN COMMUNITY

GOODS SUBJECT TO IMPORT CONTROL

DRUG PRECURSORS — REGULATION (EC) No 111/2005 IMPORT AUTHORISATION

2

1. Importer (name and address)

2. AUTHORISATION number:

COPY FOR THE AUTHORITY IN THE COUNTRY OF EXPORT

Issued (date): at:

3. Period of validity:

Beginning: End:

4. Exporter (name and address)

5. (For completion by the issuing authority) Issuing Authority

(name, address, telephone, fax, e-mail of responsible officer)

6. Other Operator(s) (name and address)

7. Competent authority of the exporting country

8. Ultimate consignee (name and address)

9. Point of entry into the Community Customs territory

10. Methods/Means of transport

11a. Scheduled substance

12a. CN code

13a. Net weight

14a. % of mixture

2

15a. Invoice number

11b. Scheduled substance

12b. CN code

13b. Net weight

14b. % of mixture

15b. Invoice number

16. Declaration by the applicant Name: Representing: (Applicant)

Signature: Date:

17. (For completion by issuing authority)

Boxes 7, 9, 10 still required YES /NO

Signature:

Function:

Date: Stamp:

18. (For completion by the customs office in the Community)

Customs reference

(declaration of entry into the procedure or reference number to the customs approved treatment or use)

Signature of officer:

Function:

Place: Date: Stamp:

EUROPEAN COMMUNITY

GOODS SUBJECT TO IMPORT CONTROL

DRUG PRECURSORS — REGULATION (EC) No 111/2005 IMPORT AUTHORISATION

3

1. Importer (name and address)

2. AUTHORISATION number:

COPY TO ACCOMPAGNY THE GOODS

Issued (date): at:

3. Period of validity:

Beginning: End:

4. Exporter (name and address)

5. (For completion by the issuing authority) Issuing Authority

(name, address, telephone, fax, e-mail of responsible officer)

6. Other Operator(s) (name and address)

7. Competent authority of the exporting country

8. Ultimate consignee

9. Point of entry into the Community Customs territory

10. Methods/Means of transport

11a. Scheduled substance

12a. CN code

13a. Net weight

14a. % of mixture

3

15a. Invoice number

11b. Scheduled substance

12b. CN code

13b. Net weight

14b. % of mixture

15b. Invoice number

16. Declaration by the applicant Name: Representing: (Applicant)

Signature: Date:

17. (For completion by issuing authority)

Boxes 7, 9, 10 still required YES /NO

Signature: Function: Date: Stamp:

18. (For completion by the customs office in the Community) Customs reference (declaration of entry into the procedure or reference number to the customs approved treatment or use) Signature of officer: Function: Place: Date: Stamp:

EUROPEAN COMMUNITY

GOODS SUBJECT TO IMPORT CONTROL

DRUG PRECURSORS — REGULATION (EC) No 111/2005 IMPORT AUTHORISATION

4

1. Importer (name and address)

2. AUTHORISATION number:

COPY FOR THE IMPORTER

Issued (date): at:

3. Period of validity:

Beginning: End:

4. Exporter (name and address)

5. (For completion by the issuing authority) Issuing Authority

(name, address, telephone, fax, e-mail of responsible officer)

6. Other Operator(s) (name and address)

7. Competent authority of the exporting country

8. Ultimate consignee (name and address)

9. Point of entry into the Community Customs territory

10. Methods/Means of transport

11a. Scheduled substance

12a. CN code

13a. Net weight

14a. % of mixture

4

15a. Invoice number

11b. Scheduled substance

12b. CN code

13b. Net weight

14b. % of mixture

15b. Invoice number

16. Declaration by the applicant Name: Representing: (Applicant)

Signature: Date:

17. (For completion by issuing authority)

Boxes 7, 9, 10 still required YES /NO

Signature: Function: Date: Stamp:

18. (For completion by the customs office in the Community) Customs reference (declaration of entry into the procedure or reference number to the customs approved treatment or use) Signature of officer: Function: Place: Date: Stamp: