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Authorization Application Form

This document is an application form for authorization from the Kenya Plant Health Inspectorate Service, requiring details about the applicant, the types of crops involved, and the specific inspections and tests requested. It includes sections for both individuals and entities to provide their qualifications and experience, as well as a declaration of understanding of relevant regulations. The form also requires a payment and an official use section for processing the application.

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58 views3 pages

Authorization Application Form

This document is an application form for authorization from the Kenya Plant Health Inspectorate Service, requiring details about the applicant, the types of crops involved, and the specific inspections and tests requested. It includes sections for both individuals and entities to provide their qualifications and experience, as well as a declaration of understanding of relevant regulations. The form also requires a payment and an official use section for processing the application.

Uploaded by

tabithaisare
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

1.

ANNEX 2: FORMS
Form AG 1

APPLICATION FOR AUTHORIZATION

To

The Managing Director


Kenya Plant Health Inspectorate Service
P.O Box 49592 - 00100
NAIROBI

1. Applicant’s Information

Name: ___________________________________________

Postal Address: ____________________________________

Physical address ___________________________________

Telephone: ________________________________________

email:____________________________________________

For Entities:

Registration certificate number (attach copy)


________________________________________

Number of technical staff ________________________ (provide list separately and


qualifications).

For Individuals:

Education level(s) _________________________________________________________


(attach certificates)

Number of years of relevant experience _______________________________________


(attach documentary evidence)

2. Aspects of authorization being sought (tick where appropriate)

i. Field inspection
ii. Processing inspection and sampling
iii. Sampling and testing
iv. Labeling and sealing

I/We wish to deal with the following crop(s) or groups of crops

i. Maize and sorghum (Both Hybrids & OPV)


ii. Small cereals (wheat, barley, oats, Millets etc.)
iii. Pulses (beans, broad bean, chickpea, cowpea, pea, Dolichos, etc.)
iv. Oil crops (sunflower, soya beans, sesame, oilseed, linseed, groundnuts
etc.)
v. Root and tuber crops (Irish potato, cassava, sweet potato, etc.)
vi. Herbage grasses (Rhodes, setaria, sudan, guinea grass, etc.)
vii. Pasture legumes
viii. Vegetables.
ix. Flowers (pyrethrum, etc.)
For laboratories:

3. I/We wish to apply for the following tests (tick appropriately)

i. Purity (compulsory)
ii. Germination (compulsory)
iii. Moisture
iv. Seed health (Specify)
v. Confirmation of transformation event
vi. Other relevant tests.

The methods for which authorizion is being sought based on 3 above:

i.______________________________________________

ii.________________________________________________

iii.________________________________________________

iv._________________________________________________

v.__________________________________________________

Do you have adequate facilities and equipment (Yes/No)

If yes list as per guidelines requirement.

i.
ii.
iii.
iv.
v.

I enclose a cheque of KShs. ------------------- in payment for this application (See the
authorization guideline on our website).

In signing this application I/We declare that I/We are conversant with the various articles
and requirements and the guidelines and also applicable clauses in the Seeds and Plant
Varieties Act (Cap 326).

Name _____________________________sign __________________Date: _____________

Name _____________________________sign __________________Date: ______________

Name _____________________________sign __________________Date: ______________

Official stamp

Attach any other relevant document as required by the guidelines.

FOR OFFICIAL USE ONLY

Application received on
__________________________________________________________

Verification verdict (Approved/Rejected)


____________________________________________

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