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INFORMATION FORM FOR ORGANIC FERTILIZER, MICROORGANISM AND OTHER ITEMS RELATED TO MICROORGANISM Regulation 3, 4(3), 5(1), dan 5(4) Plant Quarnatine Regulations 1981 Plant Quarantine Act 1976 Address to : Pengarah Bahagian Biosekuriti Tumbuhan Jabatan Pertanian, Aras 1-3, Wisma Tani, Jalan Sultan Salahuddin, 50632 Kuala Lumpur Tel: 03-20301434 Fax : 03- 26977164 A. Requirement of importing Organic Fertilizer/Microorganism/ Other items consisting of Microorganism i. To import organic fertiizer, microorganism and other items consisting of microorganism, you have to obtain the permit to import sample for analysis purposes to fulfill the required Malaysian Standard. Analysis to be conducted by 4 government agencies – Department of Agriculture, Department of Fisheries, Department of Veterinary Services and Institute for Medical Research (IMR) to ensure the item will not endanger plants, fish, livestock, humans and environment. ii. 5 sets each of the sample(fertilizer/organic material) are to be analyzed. Sample in the form of powder weighing 250 gm for each set or sample in the form of liquid 250 ml for each set. Please separate the sample precisely into 5 sets before entry into Malaysia (using the permit of sample import issued) to ensure it will not be contaminated during transportation from the country of origin. iii. Please fill in Form EP-4A to apply for permit to import sample. Kindly enclose a Postal Order for the amount RM 15.00 made payable to Ketua Pengarah Pertanian for processing fee. iv. For importing sample, the entry point entrance will only be the KLIA. v. Importer has to bear the analysis cost. Payment are as follow: (Please enclose Postal Order/Bank Draft for each of agencies) Agency Name Department of Agriculture Malaysia Department of Agriculture Malaysia Department of Fisheries Malaysia Department of Veterinary Services Analysis Cost for Made payable to each Fertilizer RM 90.00 Ketua Pengarah Pertanian RM 80.00 Ketua Pengarah Pertanian RM 120.00 Ketua Pusat, Pusat Pengurusan Kesihatan Ikan dan Kuarantin, Sepang _ Exempted 1/3 B. Please complete the information below : ( Please attached supplementary enclosure from fertilizer manufacturer ). No Information 1 Importer name and address: 2 Telephone no./ Fax no.: 3 Exporter name and address: 4 Fertilizer/product commercial name: 5 Raw material blends with fertilizer/product. Example animal dung, sugarcane waste, paddy husk and others. 1. 2. 3. 4. 5. 6 Microorganism (bacteria,fungus and others) blends with fertilizer/product. Example bacteria scientific name is Bacillus subtilis, Klebsiella pneumoniae ext. (Please enclosed certified letter from manufacturer if the fertilizer does not contain any microorganism) 1. 2. 3. 4. 5. 7 Lab procedure or protocol in the process of microorganism existence in the fertilizer/product.(Please attached) 8 Declaration from responsible authority (goverment authority) that the fertilizer/product are not containing any ingredients which can cause harmful affect to any plant, livestock, fish, human and environment.(Please attached) 9 NPK such as Nitrogen 8%,Phosporus 10%, Kalium 7% 2/3 10 Mineral such Manganese, Iron 11 Others. (If applicable) 12 Manufacturing process of fertilizer/product. Please enclosed flowchart 13 Fertilizer/product form (Solid substance/liquid/granule). 14 Country of manufacturer 16 Purpose for using the fertilizer/product. Example-Root growth 17 Fertilizer/product effect on plants. 18 Fertilizer/product effect on livestock. 19 Fertilizer/product effect on fish 20 Fertilizer/product effect on human and environment. C. 15 Other countries using this fertilizer/product Declaration I confess and believe that all the information given is true and correct. Otherwise the permits given is invalid and face charges of maximum penalty RM 1,000 or 6 month prison or both. Date : Signature : Applicant name : Designation : I/C no. : 3/3