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GM1 Article 14(6) Application for a certificate

ED Decision 2022/022/R

APPLICATION FORM — TEMPLATE

Competent authorities may wish to consider using the following application form template, for the purpose of facilitating the harmonised implementation of Regulation (EU) 2021/664.

Applicant details

(a)

Legal name of the applicant

 

(b)

Name of the USSP or the single CIS provider

 

(c)

Address of registry

 

(d)

Principal place of business

 

(e)

Telephone number

 

(f)

Email

 

Reason for application

1.

Initial issue

 

2.

Renewal

 

Declaration

(a)

Full name of the accountable manager

 

(b)

Signature of the accountable manager

 

(c)

Date of application