ブータン王国生物資源及び関連する伝統的知識第三者移転許可申請

Application form for seeking approval for third party transfer of the accessed Biological resources and/or associated Traditional Knowledge.

1. Full particular of the applicant
(a) Name:
(b) Address:
(c) Professional profile:
(d) Organization affiliation (please attach relevant documents of authentication)

2. Details of the biological material and/or traditional knowledge

3. Details of the contract/user agreement entered (Copy to be enclosed)

4. Details of the benefits and mechanism/arrangements for benefit sharing already implemented.

5. Full particulars of the third party to whom the accessed materials and/or knowledge is intended to transfer.

6. The purpose of the intended third party transfer.

7. Details of economic, social, biotechnological, scientific or any other benefits that are intended, or may accrue to the third party due to transfer of accessed biological material and knowledge.

8. Details of any agreement to be entered between the applicant and the third party.

9. Estimation of benefits that would flow to Bhutan/communities arising out of the third party transfer of accessed biological resources/biochemical resources and/or associated traditional knowledge.

10. Proposed mechanism and arrangements for benefit sharing arising out of the proposed third party transfer.

11. Any other relevant information

Declaration
I/we declare the information provided in the application form is true and correct and I/we shall be responsible for any incorrect/wrong information.

Signature…………………….
Name …………………….
Title …………………….
Place : ………………………….
Date : …………………………

←戻る