@extends('layouts.user.usercas') @section('title') REACH JOINT SUBMISSION FORM (JSF) @endsection @section('meta_description') Register your substances with us and we will help you to fulfill all compliance requirements also you can contact our experts for further details. @endsection @section('meta_keywords') REACH JOINT SUBMISSION FORM (JSF) @endsection @section('pageTitle') REACH JOINT SUBMISSION FORM (JSF) @endsection @section('content') @if($companyData != null)
@csrf @method('post')
REACH JOINT SUBMISSION FORM (JSF)
{{$companyData->cas_name}}(CAS No: {{$mainsearchData->CAS_Registry_No}}; EC No: {{$mainsearchData->EC_No}})

Lead Registrant(LR):Global Product Compliance(GPC)

Note:*Indicate mandatory field.

By signing this form you indicate an interest to become a joint submission member to the REACH Registration of the substance indicated below.Joint Registration Format has no binding on the timing of registration or registration itself, but it's a important information for LR to make various projections and also to cut short time at later date when SIEF member decides to register.

Substance Information

Name:{{$companyData->cas_name}}

CAS No:{{$mainsearchData->CAS_Registry_No}}

EC No:{{$mainsearchData->EC_No}}

See Substance Identity Profile (SIP) attached for details about substance identity.

Registrant Company Details:

Registering Legal Entity name:*
@error('entity_name')

{{ $message }}

@enderror
UUID:*
@error('uuid')

{{ $message }}

@enderror
Postal Address:*
@error('address')

{{ $message }}

@enderror
Postal Code:*
@error('code')

{{ $message }}

@enderror
Postal City:*
@error('city')

{{ $message }}

@enderror
Country:*
@error('country')

{{ $message }}

@enderror

Additional Affiliate(s) that will also register:

Legal Entity name:
(if applicable)
UUID:
(if applicable)

Registerant Contact details:

Contact Person:*
@error('contact_person')

{{ $message }}

@enderror
E-mail address:*
@error('e_mail')

{{ $message }}

@enderror
Telephone:*
@error('telephone')

{{ $message }}

@enderror

Check this box if Registrant Company Address and billing address are the same.

Registerant Billing details:

VAT number / TAX number:*
@error('vat')

{{ $message }}

@enderror
Billing Company Name:*
@error('billing_company')

{{ $message }}

@enderror (if diffrent from above)
Billing Address:
@error('billing_address')

{{ $message }}

@enderror (if diffrent from above)
Postal Code:
(if diffrent from above)
Postal City:
(if diffrent from above)
Country:
(if diffrent from above)
Additional required payment data(e.g. Purchase order if required):
(if diffrent from above)
UUID:

Registerant Bank account details:

IBAN:
Account Number:
Bank Name:
BIC/SWIFT Code:
Payment Method:
Description to be added(if required):
Additional Required payment data(if required):

Inputs for preparing the SIEF Agreement:

Scope of registration & dossier type*: