This form is for requesting new or amended access to Animal Products E-cert for an interface system (or advising MPI of changes to the responsible person contract details).

 Send this completed form electronically to CVM.ManufacturingandAssurance@mpi.govt.nz
 Along with the form, provide formal verification of this name change in the form of a letter or equivalent.
 Manufacturers who are Registrants: Please complete a C2 application (and update your Product Data Sheet) to ensure your name change is reflected in your ACVM product registrations that are impacted by this name change.
 Contract Manufacturers: Please advise the registrant of the ACVM registered products you manufacture of your company’s name change so they can complete a C2 application and update their approved Product Data Sheet and ensure their product registration remains current.
 Refer to the Privacy Act 1993 and Official Information Act 1982 notices at the end of this form regarding collection of information by the Ministry for Primary Industries.

This section has been substantially changed since 1 March 2017.

This section has been substantially changed since 1 March 2017.

Apply for recognition as a Pesticide Analytical Laboratory, or renew recognition or change details.

Certified suppliers must complete this declaration for live possums intended for human consumption. Form includes details of poison buffer zones.

ETSJA.5

ETSAR. 7