E-mark Application Form

Packer or Importer Select TypePackerImporter

Name

Address

Phone Number

Email Address

Name of company shown on label:

Agent responsible for packing (as marked on the label) or code mark:

Name of goods shown on label:

Nominal quantity:

Expected date(s) of packing:

Number of packages to be e-marked:

Has this product previously been e-marked for export:

Yes No

Quantity checks (Specify):

Submitted By

Address

Email Address

Phone Number