ANNEX II FORM FOR SELF-DECLARATION OF CONFORMITY

ANNEX II

FORM FOR SELF-DECLARATION OF CONFORMITY

…

(name and address of the economic operator)

declares under its sole responsibility that the handling of plastic pellets in the installation located in ……………………………………………………………………………… (address) with registration number (if available) ……………………………………… meets all the requirements of Regulation (EU) 2025/2365 of the European Parliament and of the Council of 12 November 2025 on preventing plastic pellet losses to reduce microplastic pollution.

By signing this declaration, I declare that the measures set out in the risk assessment attached, which was carried out on the ……………………………………… (date), have been implemented.

Done at ………………………………………, on …/…/20… .

Signature