
Article 1 
The form to be used by Member States when granting or denying written consent pursuant to the second subparagraph of Article 4(1) of Regulation (EU) 2017/852 is set out in Annex I to this Decision. However, this Article does not apply in the case of imports of mercury, or a mixture of mercury, that qualifies as or is considered to be waste within the meaning of Directive 2008/98/EC of the European Parliament and of the Council.
Article 2 
Member States may grant written consent pursuant to the second subparagraph of Article 4(1) of Regulation (EU) 2017/852 in the circumstances set out in point (b) of that subparagraph only if the certification required by that point is in the form set out in Annex II to this Decision. However, this Article does not apply in the case of imports of mercury, or a mixture of mercury, that qualifies as or is considered to be waste within the meaning of Directive 2008/98/EC.
Article 3 
This Decision shall apply from 1 January 2018.
Article 4 
This Decision is addressed to the Member States.
Done at Brussels, 8 December 2017.
For the Commission
Karmenu VELLA
Member of the Commission
ANNEX INote: This form applies to the import into the European Union of mercury and of mixtures of mercury with other substances, including alloys of mercury, with a mercury concentration of at least 95 % by weight, as listed in Annex I to Regulation (EU) 2017/852 on mercury (‘mixtures of mercury’). This form does not apply in the case of imports of mercury, or a mixture of mercury that, qualifies as or is considered to be waste within the meaning of Directive 2008/98/EC on waste. Section A: 
Name of the designated national focal point:

Address:

Tel.:

Fax:

Email:
 Section B: 
Name of designated national focal point or responsible government official:

Address:

Tel.:

Fax:

Email:
 Section C: 

((i)) Please indicate the intended total quantity of mercury, whether in pure form or in mixtures, to be shipped (kg)
((ii)) Please indicate the intended date(s) of shipment(s)
((iii)) Please indicate if the mercury, whether in pure form or in mixture, is from primary mercury mining: If YES: 
If the exporting country is a non-Party, it has provided certification that the mercury is not from primary mercury mining.

((iv)) Please confirm that the mercury whether in pure form or in mixture is not from any of the three following sources:

— the chlor-alkali industry (e.g. decommissioning of chlor-alkali cells),
— the cleaning of natural gas,
— non-ferrous mining and smelting operations.
 Section D: 
What is the purpose of the import of the mercury whether in pure form or in mixtures? Please circle:


((i)) Environmentally sound interim storage in accordance with Article 7(3) of Regulation (EU) 2017/852

YES NO
If yes, please specify the intended use if known.
…
…
…
((ii)) Use allowed under Union and national legislation:
YES
NO
If yes, please specify additional details about the intended use of the mercury whether in pure form or in mixture.
…
…
…
 Section E: 
Name of business:

Address:

Tel.:

Fax:

Email:

Name of business:

Address:

Tel.:

Fax:

Email:
 Section F: 
Nature of consent, please circle:


GRANTED DENIED

Please use the space below to indicate any conditions, additional details or relevant information.

…

…

Signature of the importing Member State designated competent authorities and date


— Name
— Title:
— Signature:
— Date:

ANNEX II Section A: 

((i)) Please indicate the intended total quantity of mercury whether in pure form or in mixtures to be shipped
((ii)) Please indicate the intended date(s) of shipment(s)
 Section B: 
Name of business:

Address:

Tel.:

Fax:

Email:

Name of business:

Address:

Tel.:

Fax:

Email:
 Section C: 
In accordance with Article 3(8) of the Minamata Convention on Mercury, my Government certify that the mercury included in the shipment described in this form is not from primary mercury mining

Please, provide supporting information on the source of the mercury to be exported

Signature of responsible government official and date:


— Name
— Title:
— Signature
— Date:
