GEFプロジェクト事前情報に基づく伝統的知識アクセス承認（PIC）標準申請

PRIOR INFORMED CONSENT AGREEMENT

Dear Traditional Knowledge Holder(s),

The researcher(s)
(name)
and (name)
and (name),
from the Research Institution
(name of institute),

intend to conduct a research project which involves collecting and using traditional knowledge and practices related to the use of crop diversity in your farm.

The research is described here: Objectives…………………………………………………………………………………………….. Scope……………………………………………………………………………………………………. Purpose of the use of traditional knowledge……………………………………………………..

We would like to get your consent to collect and use the traditional knowledge and practices. With this purpose, please tick the appropriate boxes of the Agreement and sign in front of each of them.

FOR INDIVIDUAL HOLDERS

? Can (Name of the Research Institution) use your traditional knowledge in its research activities? □Yes □No

? Can (Name of the Research Institution) share your contact details with those interested in your traditional knowledge/practice? □ Yes □ No

? Can (Name of the Research Institution) share your traditional knowledge with other individuals and institutions? □ Yes □ No

? Can (Name of the Research Institution) publish your traditional knowledge on the Internet/ a magazine or any other media? □ Yes □ No

? Should (Name of the Research Institution) include your name as the source of the traditional knowledge in any publication where such knowledge is mentioned or used? □ Yes □ No

? If Yes, to what extent can (Name of the Research Institution) share your traditional knowledge
□ Partial disclosure: only a summary
□ Full disclosure

? Would you like (Name of the Research Institution) to pursue further research on your traditional knowledge (if applicable)? If yes, please specify …………………………………………………………………………………………………….

? Would you like to be informed about how your traditional knowledge has been used by (Name of the Research Institution)? □ Yes □ No

FOR A COMMUNITY

? Name of the community’s authorized leader elected …………………………………………………………………………………………………… traditional……………………………………………………………………………………………….

? Can (Name of the Research Institution) use the traditional knowledge of the community in its research activities? □ Yes □ No

? Can (Name of the Research Institution) share the address of the community with those interested? □ Yes □ No

? Can (Name of the Research Institution) share the community´s traditional knowledge with other individuals and institutions? □ Yes □ No

? Can (Name of the Research Institution) publish the traditional knowledge on the Internet/in a magazine or any other media? □ Yes □ No

? Should (Name of the Research Institution) refer to the community as the source of the traditional knowledge in any publication in which such traditional knowledge is mentioned? □ Yes □ No

? If Yes, to what extent can (Name of the Research Institution) share the traditional knowledge?
□ Partial disclosure/summary
□ Full disclosure

To what extent is specific traditional knowledge/community knowledge known and / or practiced within or among the concerned communities?
□ Known to few
□ Known to many
□ Known widely
□ Practiced by few
□ Practiced widely
□ Practiced by many

? Should (Name of the Research Institution) inform the community about how its traditional knowledge has been used? □ Yes □ No

Declaration:

I/We have read this Prior Informed Consent Form carefully and have understood the implications of sharing my/our traditional knowledge in the context of the research project described above.

I/We have voluntarily decided to select the option/ options which I/we have ticked above.

I/We assure (Name of the Research Institution) that all the information given here is correct (true) to the best of my/our knowledge, understanding and belief.

Name and Address of the Community/Traditional Knowledge Holder ……………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………. …………………………………………………………………………………………………………………….

Signature………………………………………………………………………………………………..

Name and Address of (Name of the Research Institution)

Representative: ………………………………………………………………………………………. Signature………………………………………………………………………………………………… Date……………………………………………………………………………………………………….

³ https://www.cbd.int/abs/doc/bioversity-guidelines-en.PDF

←戻る