ウガンダ共和国事前の情報に基づく同意申請

APPLICATION FOR PRIOR INFORMED CONSENT　Regulation 12(1)

FIRST SCHEDULE
THE NATIONAL ENVIRONMENT (ACCESS TO GENETIC RESOURCES AND BENEFIT　SHARING) REGULATIONS, 2005
APPLICATION FOR PRIOR INFORMED CONSENT

To*: ……………………………………　
…………………………………..………………….….. (lead agency)
…………………………………………………………. (Local Community)
…………………………………………………………(Owner)
I / we*
………………………………………………………………………………………
………………………
of
………………………………………………………………………………..…………
(address)

hereby apply for prior informed consent to enable me/us to apply to the competent authority to access genetic resources under your ownership / jurisdiction.
The prior informed consent is being applied for, for the genetic resources located at
……………………………………………………………………………………………
(State location by local council, village, parish, sub-county and district)
The prior informed consent is being applied for in respect of the following genetic resources:
……………………………………………………………………………………………

I / we* declare that I am / we* are willing to enter into an accessory agreement with you on terms and conditions acceptable to you.

I / we* hereby further declare that to the best of my / our information the information given in this application is correct and true and that the prior informed consent will only be used for applying to the competent authority to access genetic resources from Uganda

Date: ……………………….

Signature of applicant:………………………………………………………………

FOR OFFICIAL USE ONLY
Application received on: …………………………………………………………….
Guidelines for Access to Genetic Resources and Benefit Sharing 31
dd ? mm – yyyy
*Delete whichever is not applicable

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