ERP Customer’s Statement The Control of Explosives Precursors and Poisons Regulations 2023
Please complete the following form
Name of company:
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Address:
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VAT number or company registration number:
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Trades / business / profession:
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Name of person (authorised representative)
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Proof of identity (photographic ID)
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Please Select
Passport
Business ID card
UK photo driving licence
EU national ID card
Other - please specify
Please indicate which photographic ID you are providing a copy of:
If Other specify here:
Details of photographic ID provided
Please state the number and issuing authority for the proof of identity. (For a UK driving licence, the issuing authority is DVLA. For UK passports, the issuing authority is HM Passport Office - HMPO.)
Identity Number
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Issuing Authority
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Please upload a copy of the photographic ID you are providing a copy of
*
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Commercial/Trade Name of Product, Reason for Inclusion & Intended Use
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Choose Option
BP245-5 /10 / 20 - JG Premium Peroxide Laundry, Hydrogen Chloride 15-30%, Laundry Stain Removal, Destainer
BA091-5 - Jangro General Acid Cleaner, General Acid Descaling, Hydrogen Chloride 15-30%
CLV502-1 - Clover Acid Wash, Descaling Surfaces, Hydrogen Chloride 15-30%
OSLIT - One Shot Drain Cleaner, Unblocking Drains, Sulphuric Acid 96%
Declaration
I hereby declare that the commercial product and the substance or mixture that it contains shall be used only for the indicated use, which is in any case legitimate, and will be sold or delivered to another customer only if they make a similar declaration of use, respecting the restrictions established under the Poisons Act 1972 as amended by the Control of Explosives Precursors and Poisons Regulations 2023. Data will be handled in accordance with GDPR guidelines.
Signature
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Name
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First Name
Last Name
Job title/role
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This statement is valid for 18 months from the date of signature
Date
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Day
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Month
Year
Date
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