REQUEST FOR THE FURNISHING OF SAMPLES OF DEPOSITED MICROORGANISMS

 STUDENT ID DUPLICATE CREDENTIAL REQUEST FEE CHARGED
(JAWAPAN PADA SLAID) 1 A MANAGER REQUEST HIS
048B DATE OF BIRTHADDRESS CHANGE REQUEST FORM

2 REQUEST FOR NCG FUNDING FOR RITUXIMAB
2 REQUEST FOR URGENT CITIZENSHIP CEREMONY –
APPLICATION TO THE REGISTRAR TO REQUEST THE PRODUCTION

BUDAPEST TREATY ON THE INTERNATIONAL RECOGNITION OF THE DEPOSIT OF

REQUEST FOR THE FURNISHING OF SAMPLES OF DEPOSITED MICROORGANISMS

Request for the furnishing of samples of

deposited micro-organisms pursuant to Rule 11.2.(ii)

BCCM/MUCL/BP/11

F425D

17/12/2013

Page 1 of 2


BUDAPEST TREATY ON THE INTERNATIONAL RECOGNITION OF THE DEPOSIT OF

MICRO-ORGANISMS FOR THE PURPOSES OF PATENT PROCEDURE



To:


Belgian Coordinated Collections of Micro-organisms (BCCM)

Université catholique de Louvain

Mycothèque de l’Université catholique de Louvain (MUCL)

Croix du Sud 2, box L7.05.06

1348 Louvain-la-Neuve

Belgium



Form

BCCM/MUCL/BP/11/

.....


(number to be filled in by IDA)


The undersigned authorized party hereby requests the furnishing of a sample of the micro-organism identified hereunder, in accordance with Rule 11.2.(ii) of the Regulations under the Budapest Treaty.


I. Identification of the micro-organism

Accession number given by the International Depositary Authority:      

II. Declaration of the depositor

The undersigned depositor of the micro-organism identified under section I above hereby authorizes the furnishing of a sample of the said micro-organism to the party specified under section IV below.

Name or institution*:      


*In case the depositor is a legal entity, the authorized representing person according to BCCM/MUCL/BP/1 is:

Name:      

Function:      


Address:      

     

     

Date:       Signature:

III. Declaration of the authorized party

The undersigned authorized party declares that

1. during the period of validity of the patent, no samples of the micro-organism or of material that is derived from the micro-organism will be made available to third parties;

2. during the period of validity of the patent, the sample of the micro-organism or of material that is derived from the micro-organism will only be used for experimental purposes.

IV. Request for information

The undersigned authorized party


requests;

does not request


an indication of the conditions which the International Depositary Authority employs for the cultivation and storage of the micro-organism.

V. Authorized party

Name or institution*:      


* Where the signature is required on behalf of a legal entity, the typewritten name(s) of the natural person(s) signing on behalf of the legal entity should accompany the signature(s).

Name:      

Function:      


Address:      

     

     

Date:       Signature:


Note: This form has to be filled out in duplicate!




CHAIRMAN PHIL MENDELSON AT THE REQUEST OF THE
FREEDOM OF INFORMATION ACT REQUEST PLEASE REVIEW
FRESNO COUNTY EMPLOYEES’ RETIREMENT ASSOCIATION REQUEST FOR PROPOSAL


Tags: deposited micro-organisms, request, deposited, samples, microorganisms, furnishing