1.

Name of Appellant:

2.

Physical address of Appellant:

3.

Telephone or Cell phone number:

4.

E-mail address

5.

Product type and description (cultivar, style, grade/class, etc.):

Please also tick P

Destined for Export         £

Imported Products           £

Local Products                   £

6.

Number of containers/packages:

7.

Point of inspection:

8.

Date of inspection

9.

Name of assignee or other authority responsible:

10.

Name of inspector:

11.

Decision or direction being appealed against:

12.

Grounds for appeal:

13.

Any other remarks or comments:

14.

Applicable appeal fees has been paid and proof of payment is attached (please tick P)

YES £                                    NO £

(Relevant banking details obtainable from Executive Officer)