ANNEX 3
NECESSARY FORMS FOR EACH JURISDICTION
Australian forms
1 Assessment certificates
1.1/ STD (Standard Notification);
Form STD-1
Checklist (Standard Notification)
Electronic template submissions - Mandatory forms
Form NCN - Template Notification Form and Checklist
Schedule Attachment Part A
Schedule Attachment Part B
Schedule Attachment Part C1
Schedule Attachment Part C2
Schedule Attachment Part AD
1.2/ LTD (Limited Notification);
Form LTD-1
Checklist (Limited Notification)
Electronic template submissions - Mandatory forms
Form NCN - Template Notification Form and Checklist
1.3/ PLC (Polymer Of Low Concern)
Mandatory forms for non-template submissions
Form PLC-1
Checklist (Polymer of Low Concern Notification)
Self assessment
Mandatory forms for polymer of low concern (PLC)
Form 1 - PLC Self Assessment
Mandatory forms for Non PLC
1
Form 1 - Non PLC Self Assessment
1.4/ EXT (Extension Application);
Form EXT 1 - Extension of an Original Assessment Certificate
Form 14 - Agreement to Extension of Original Assessment Certificate
1.5/ Secondary Notification;
Mandatory forms for secondary notification
Form SN 1 - Secondary Notification
1.6/ Self Assessment (see PLC)
1.7/ Form 73 - Agreement to transfer an Assessment Certificate.
Form 73
Canadian forms
New Substances Notification Reporting (NSN) Form for chemicals, Polymers, Biochemicals and
Biopolymers
Formulaire de Déclaration de Substances Nouvelles (DNS) pour les substances chimiques,
polymères, biochimiques et biopolymères
Domestic Substances List Reporting Form / Substance à Inscrire sur la Liste Intérieure
New Substances Notification Reporting Form for Organisms other than a Micro-Organism /
Formulaire de Déclaration de Substances Nouvelles à l'égard des Organismes autres que les Micro-
organismes
New Substances Notification Reporting Form for Micro-Organisms / Formulaire de Déclaration de
Substances Nouvelles à l'égard des Micro-organismes
Domestic Substances List Reporting (Substances Proposed for the Confidential Portion of the
Non-Domestic Substances List) / Substance à Inscrire sur la Liste Intérieure (Substances à Être
Inscrite à la Partie Confidentielle de la Liste Extérieure des Substances)
US form
PMN Form (Premanufacture Notification)
2
Japanese forms
A. Chemical Substances Control Law (CSCL)
1. Notification of manufacture/import of a new chemical substance
Form 1 (Related to Article 2), Form 1-2 (related to Article 2-2)
2. New chemical substance card (so called blue card)
3.1 Report on degradation test results
3.2. Report on concentration test results1
3.3 Report on 1-octanol/water partition coefficient measurement test results
3.4 Report on Reverse Mutagenicity test on bacteria test results
3.5 Report on Chromosome aberration test using cultured mammalian cells test results
3.6 Report on 28-day repeated dose toxicity test using mammals test results
3.7 Report on Algae Growth Inhibition test results
3.8 Report on Daphnia acute immobilization test results
3.9 Report on fish acute toxicity test results
B. Industrial Safety and Healthy Law (ISHL)
1. Notification of manufacture/import of a new chemical substance
Korean forms
Application for Assessment of New Chemical Substance
Summary of Test Report (and experimental data)
Application for Confidential Data Protection
Swiss form2
SNIF-form (Structured Notification Interface Format)
European (REACH) forms2
IUCLID 5
1 This data is required if log POW>=3.5.
2 For Europe (Switzerland and REACH), the system will not deliver the templates for the hazard endpoints
but will enable to import selectively administrative fields from the softwares used for notification in these
jurisdictions (respectively DES (Data Entry Screens) software and IUCLID 5).
3
4