ivc15 – 国立遺伝学研究所ABS学術対策チーム

南アフリカバイオ探索研究標準輸出許可申請

PART 2: APPLICATION FOR AN EXPORT PERMIT FOR THE PURPOSES OF BIOPROSPECTING

An applicant completing this part must also complete and sign part 1

1.RECIPIENT OF INDIGENOUS BIOLOGICAL RESOURCES BEING EXPORTED (IMPORTER)

Name of recipient / importer:
Tel No:
Fax No:
E-mail:
Postal Address	Physical Address

2.REQUIREMENTS OF OTHER LEGISLATION
Name of Legislation
Reference number
Waybill numbers (where appropriate)

3.PURPOSE OF EXPORT

4. Benefits of intended bioprospecting to:
Yes No
The conservation of biodiversity of South Africa
The economic development of South Africa
Any other matter that is in the public interest

IF YES, PROVIDE DETAILS

5.FEES

Departmental Bank Account Pretoria ABSA Bank South Africa Account number: 1044240072 Branch code : 632005 ACCOUNT TYPE: CURRENT Swift Account : ABSA ZAJJ CPT ( OUDSIDE SA) REFERENCE NUMBER: 00946420 & Depositors Details (i.e. your full name and/or company etc.)
R5 200 application fee paid
Yes	No
If yes (attach copy of invoice)

Signature of Applicant
Date
Capacity

ENDORSEMENT OF JURISTIC BODY, IF APPLICABLE

Name Signature of duly authorized officer
Date

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