Date of receipt (DD/MM/YYYY) …
[to be completed by the Commission]
Number of pages (including this page) …
Language used for submission of application …
File number [to be completed by the Commission] …
Name of legal or natural person …
Full address (street number and name, town/city and postal code, country) …
Legal status (in the case of legal persons) …
Nationality …
Member State(s) (*) …
Third-country authority (*) …
[(*) delete as appropriate] U.K.
Name(s) of intermediary(ies) …
Full address(es) (street number and name, town/city and postal code, country) …
Designation of origin (*) …
Geographical indication (*) …
[(*) delete as appropriate] U.K.
Description of the wine(s)(1) …
Maximum yield(s) per hectare …
Including a reference to the products covered by Article 118a(1) of Regulation (EC) No 1234/2007.
Article 118u(1) of Regulation (EC) No 1234/2007.
Optional.
Describe the specific nature of the product and geographical area and the causal link between the two.’