export licence form nov09 by rgrVhQ3

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									                                          EXPORT LICENCE APPLICATION

NOTES FOR GUIDANCE

1.    An export licence under the Misuse of Drugs Act 1971 is required for any substance for the time being falling within
      Schedules 1, 2, 3, and 4 (Parts I and II) to The Misuse of Drugs Regulations 2001 or Poppy Straw.

2     Copies of the Act and Regulations may be obtained from The Stationery Office, 123 Kingsway, London WC2B 6PQ or e-
      mail: london.bookshop@tso.co.uk; 17 Lothian Road, Edinburgh EH3 9AZ or e-mail: enquiries@tsoscotland.com; 16
      Arthur Street, Belfast BT1 4GD or e-mail: belfast.bookshop@tso.co.uk; or through UK agents: see
      www.tso.co.uk/contact/bookshops/agents/ for details.)

3.    Export licences will normally only be issued against a relevant original import certificate, or letter of exemption issued by
      the appropriate authority of the importing country, which should be sent with this application along with a photocopy of
      that permit/exemption document

4.    Any licence issued in response to this application will be for a specific quantity of drug or drugs and it will not be
      permissible for greater quantities, or material not of the specified description on the licence, to be exported under it.

5.    A licensee may not make amendments of any kind to an export licence. If after issuance of a licence an error is recognised,
      or specific drug details are no longer relevant the licence must be returned to Drugs Licensing, Home Office requesting
      cancellation. A fresh application should be made for the revised requirement. No amendments will be made to existing
      licences.

6.    The attention of applicants is directed to Section 18(4) of the Misuse of Drugs Act 1971, which makes it an offence,
      punishable by imprisonment or fine or both, for any person to make a declaration or statement which is false in any
      particular for the purpose of obtaining the issue, grant or renewal of any licence or authority under the Act.

INSTRUCTIONS FOR COMPLETING THIS FORM

1.    You must complete all 4 pages of the following application form (including the cover sheet), other than those areas shaded
      in grey, which are for official use. Failure to complete all pages correctly may result in your application being rejected.

2.    BOX 1 – COMPANY APPLICATION REFERENCE: Applicants are asked to provide a unique reference on each
      application and to quote this reference in any further communication. Further communications can be dealt with more
      expeditiously if your reference relates to one application only.

3.    BOX 7 – PARTICULARS OF EACH ITEM TO BE EXPORTED: The requirements below should be observed:

      (a)    Weights should be stated in metric measures to three decimal places. Commas should not be used. The conversion
             to base drug at BOX 8 should always be quoted in grammes.

      (b)    Not more than one item should appear on each line.

      (c)    Each item should be separately and fully described. The quantity and form in which the item will be exported
             should be stated e.g. 200 x 12 x 2.15ml ampoules pethidine hydrochloride 100mg/2ml containing X grammes
             pethidine base (overage should be included where applicable) and the following additional information should be
             given in respect of:

             (i)       Crude Drugs: State the percentage of pure drug content.

             (ii)      Preparations: The drug content of opium preparations should be given in terms of anhydrous morphine.
                       The drug content of all other preparations should be given in terms of the relevant anhydrous base.
      (d)    Not more than 4 different base drugs may be entered on each application.

4.    BOX 9 must be signed by a named responsible individual. If the importer is an individual, he must be named, if it is a
      partnership, a partner must be named; if it is a company, a Director or the Company Secretary must be named.

5.    The completed application should be sent by recorded delivery to NEW EXPORT APPLICATIONS, DLCU, 4th Floor,
      Fry Building, Home Office, 2 Marsham Street, London SW1P 4DF. It should consist of the Export Licence
      Application Cover Sheet, the 3 page application, the original import permit, or letter of no objection and a
      photocopy of that document

6.    BOXES 10 and 12 of page 1 of the licence must be completed immediately following exportation and returned to this
      office immediately following shipment.
APPLICATION FOR EXPORT LICENCE – COVER SHEET

1   Licensee (name of Company)




2   Application reference




3   Contact name(s)




4   Contact telephone number(s)




5   Contact email address(es)




6   Confirm the Home Office licence number given to
    supply these drugs




7   Signature (to match that given on the application)
                                                                                                                                              MISUSE OF DRUGS ACT 1971

                                                                                                                                         EXPORT LICENCE (VERSION 11/09)

                                                                       1. Exporter (name, address and telephone number):                                     2. Licence Number:
1
                                                                                                                                                                                       ___________________________________________________________




                                                                                                                                                             3. Expiry date:
                                                                       Company Application Reference:
THIS COPY TO BE RETURNED BY LICENSEE TO HOME OFFICE FOLLOWING EXPORT




                                                                                                                                                             5. Issuing Authority:
                                                                       4. Importer in the country of destination (name and address):

                                                                                                                                                             Drugs Licensing & Compliance Unit, Home Office, 4th Floor Fry,
                                                                                                                                                             2 Marsham Street, London SW1P 4DF


                                                                                                                                                             6. Reason for shipment:
                                                                       Import authorisation No:

                                                                                                                                                             Is this shipment intended for RE-EXPORT or DOMESTIC USE?
                                                                       Date of Issue:                               Date of Expiry:
                                                                                                                                                             (please delete as appropriate)

                                                                                                                                                             If for RE-EXPORT you MUST state the name of the country to which the
                                                                                                                                                             drug(s) will finally be shipped:

                                                                                                                                                             _____________________________________________________________

                                                                       7. Particulars of each item to be exported (maximum 4 different base drugs per application)                   8. Conversion to base drug (in grammes to 3 decimal places) for each
                                                                                                                                                                                     item:




1
                                                                       9. Signature of applicant:


                                                                       Print Name: _________________________________________________________________                   Position: _______________________________________________________________


                                                                       Date _______________________________________________________________________


                                                                       10. Important: Has the whole consignment for which the licence has been granted been exported? - YES/NO (Please delete as appropriate)
                                                                                     If not, please give details below of the actual amount exported in anhydrous base and in gram mes:




                                                                       11.                                                                                              12. Important: CONFIRMATION OF EXPORT FROM THE UK (SEE BOX 10)
                                                                                                                                                                        (For completion by licensee and return to the Home Office immediately following
                                                                       Signature: __________________________________________________________________                    exportation)
                                                                                                                                                                        Date of export: ________________________________________________________
                                                                       Date: ___________________________                   Stamp:
                                                                                                                                                                        Signature: ____________________________________________________________


                                                                                                                                                                        Responsibility in Organisation: __________________________________________


                                                                                                                                                                        Date of signature: _____________________________________________________




                                                                                  N.B. THIS LICENCE IS NOT VALID WITHOUT AN EMBOSSED SEAL IN BOX 11
                                                                                                                      MISUSE OF DRUGS ACT 1971

                                                                                                                 EXPORT LICENCE (VERSION 11/09)

                                               1. Exporter (name, address and telephone number):                                     2. Licence Number:
2
                                                                                                                                                               ___________________________________________________________




                                                                                                                                     3. Expiry date:
                                               Company Application Reference (unique to this application):

                                                                                                                                     5. Issuing Authority:
                                               4. Importer in the country of destination (name and address):

                                                                                                                                     Drugs Licensing & Compliance Unit, Home Office, 4th Floor Fry
                                                                                                                                     Building, 2 Marsham Street, London SW1P 4DF
THIS COPY FOR THE COMPETENT AUTHORITY ABROAD




                                                                                                                                     6. Reason for shipment:
                                               Import authorisation No:

                                                                                                                                     Is this shipment intended for RE-EXPORT or DOMESTIC USE?
                                               Issue Date:                            Expiry Date:
                                                                                                                                     (please delete as appropriate)

                                                                                                                                     If for RE-EXPORT you MUST state the name of the country to which the
                                                                                                                                     drug(s) will finally be shipped:
                                                                                                                                     _________________________________________________________

                                               7. Particulars of each item to be exported (maximum 4 different base drugs per application)                   8. Conversion to base drug (in grammes to 3 decimal places) for each
                                                                                                                                                             item:




2
                                               9. Signature of applicant:

                                               Print Name: _________________________________________________________________                    Position: ______________________________________________________________

                                               Date: ______________________________________________________________________
                                                                                                                       MISUSE OF DRUGS ACT 1971

                                                                                                                  EXPORT LICENCE (VERSION 11/09)

                                                1. Exporter (name, address and telephone number):                                     2. Licence Number:
3
                                                                                                                                                                ___________________________________________________________




                                                                                                                                      3. Expiry date:
                                                Company Reference Number (unique to this application):

                                                                                                                                      5. Issuing Authority:
                                                4. Importer in the country of destination (name and address):

                                                                                                                                      Drugs Licensing & Compliance Unit, Home Office, 4th Floor Fry
                                                                                                                                      Building, 2 Marsham Street, London SW1P 4DF
THIS COPY TO ACCOMPANY THE CONSIGNMENT ABROAD




                                                                                                                                      6. Reason for shipment:
                                                Import authorisation No:

                                                                                                                                      Is this shipment intended for RE-EXPORT or DOMESTIC USE?
                                                Issue Date:                             Expiry Date:
                                                                                                                                      (please delete as appropriate)

                                                                                                                                      If for RE-EXPORT you MUST state the name of the country to which the
                                                                                                                                      drug(s) will finally be shipped:
                                                                                                                                      _____________________________________________________________

                                                7. Particulars of each item to be exported (maximum 4 different base drugs per application)                   8. Conversion to base drug (in grammes to 3 decimal places) for each
                                                                                                                                                              item:




3
                                                9. Signature of applicant:

                                                Print Name: _________________________________________________________________                   Position: _______________________________________________________________

                                                Date: ______________________________________________________________________




                                                10.


                                                Signature: __________________________________________________________________


                                                Date: ______________________________________________________________________




                                                Stamp:




                                                           N.B. THIS LICENCE IS NOT VALID WITHOUT AN EMBOSSED SEAL IN BOX 10

								
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