Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697707526635.pdf (Zimbabwe)
FERTILIZERS, FARM FEEDS AND REMEDIES ACT [CHAPTER 18:12] PESTICIDE REGULATIONS APPLICATION FOR IMPORT/EXPORT PERMIT (To be submitted to a registering officer in triplicate together with a proforma invoice, diploma of registration as a pesticide retailer and application fee) Form P.5 Receipt Number……………………… Please tick appropriate box Pesticide importer Pesticide exporter 1.
Name ...................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... 2.
Address— (a) Postal ................................................................................................................................................ (b) Business ............................................................................................................................................ 3.

Type of pesticide to be imported/exported (Fungicide, insecticide, e.t.c.)
............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... 4.
Quantity to be imported/exported .............................................................................................................. ............................................................................................................................................................... 5.

Chemical group ...................................................................................................................................... 6.
Chemical name ....................................................................................................................................... 7.

Registration number ............................................................................................................................... 8.

Trade/brand name .................................................................................................................................. 9.
Name and details of person or company from which pesticide is to be imported from/exported to ...... ............................................................................................................................................................... ............................................................................................................................................................... 10 Pesticide Formulation Plant Inspection Date................................Month..............................Year..... .....
I the undersigned declare that the information provided in this form is true and understand that any misrepresentation of facts is an offence under these regulations.

_____________________________ _________________________________ Name in full Authorised Signatory Designation .......................................................................................