Insecticide Usage Compliance Declaration
Operator / Applicator Details
Full Name
Organization / Company
Contact Information
Insecticide Application Details
Insecticide Used
Crop Treated / Location
Date of Application
Application Rate & Method
Purpose / Target Pest
Compliance Statement
I hereby declare that the application of the above insecticide was carried out in accordance with all relevant national and local regulations, including adherence to label instructions and safety procedures.
Additional Comments
Date
Signature
Name