الاسم الشائع:
Information on National Focal Point of the Stockholm Convention in the nominating Party: Name: __________________________________________________________ Institution: ______________________________________________________________________ Address: ______________________________________________________________________ Telephone: ____________________________________________________________________ Fax: _________________________________________________________________________ E-mail:________________________________________________________________________ Contact information for nominating Party: Name of contact person: __________________________________________________________ Ministry: ______________________________________________________________________ Address: ______________________________________________________________________ Telephone: ____________________________________________________________________ Fax: _________________________________________________________________________ E-mail:________________________________________________________________________ Date of request for exemption: ____________________________ (day/month/year) Date of expiration of exemption: __________________________ (day/month/year) Identity of substance: Common name: ____________________________________________________________ Chemical name: ____________________________________________________________ CAS number: ______________________________________________________________ Type of chemical (pesticide, industrial chemical, intermediate): _________________________________________________________ Justification for the exemption: ____________________________________________________ ________________________________________________________________________________ Existing national regulatory controls: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Information on existing stockpiles of industrial chemicals and pesticides 1) : Quality: __________________ Quantity (in kg):________________ Quality: __________________ Quantity (in kg):________________ Monitoring and inspection activities: ________________________________________________________________________________ ________________________________________________________________________________