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Request for the furnishing of samples of deposited micro-organisms pursuant to Rule 11.2.(ii) BCCM/MUCL/BP/11 |
F425D |
17/12/2013 |
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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
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Form BCCM/MUCL/BP/11/ .....
(number to be filled in by IDA) |
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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.
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I. Identification of the micro-organism |
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Accession number given by the International Depositary Authority: |
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II. Declaration of the depositor |
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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. |
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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: |
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III. Declaration of the authorized party |
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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