EN 30.7.2005 Official Journal of the European Union Box 11 Item No: This box needs to be completed on the back of the form only. Please ensure that the Item No corresponds to the printed item number in Box 11 found next to the description of the relevant item on the view side. Box 14: Specific requirements and conditions: If there is not sufficient space in box 14, please continue on an attached blank sheet, mentioning the authorisation number. Please indicate the number of attachments in box 16. Box 16: Number of attachments: Please indicate the number of attachments, if any (see explanations to boxes 10 and 14). L 200/19

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