アフリカユニオン遺伝資源伝統的知識利益配分契約

Benefit Sharing Agreement

Application for permit if applicant is a juristic body
Name of institution or body: ___________________________________________ Registration number of institution or body: _______________________________
Contact details of institution or body (including postal/physical address, phone, fax and e-mail address): __________________________________________________________________ __________________________________________________________________ Name of contact person in the institution or body: _________________________
Capacity of contact person: ___________________________________________

Application for a permit if applicant is a natural person
Name of applicant: ___________________________________________________ Identity number of applicant: __________________________________________ Contact details of applicant (including postal/physical address, phone, fax and e-mail address): __________________________________________________________________ __________________________________________________________________

Provider of access to indigenous biological resources (if applicable)
Name: ____________________________________________________________ Capacity: __________________________________________________________
If entering into agreement in a representative capacity, state name of principal: __________________________________________________________________ __________________________________________________________________ Contact details (includes physical/postal address, telephone, fax and e-mail address): __________________________________________________________________ __________________________________________________________________

Indigenous community (if applicable)
Description of indigenous community: __________________________________________________________________ __________________________________________________________________

Name of indigenous community representative who will sign this agreement on behalf of the indigenous community: __________________________________________________________________ Capacity: __________________________________________________________ Contact details (includes physical/postal address, telephone, fax and e-mail address) of the indigenous community representative: __________________________________________________________________ __________________________________________________________________

A resolution adopted by the indigenous community must be attached to this form. The resolution must confirm that the indigenous community representative indicated above has been authorized to enter into this agreement on behalf of the indigenous community; that the indigenous community has full knowledge of the bioprospecting project; and that it consents to entering into this Benefit Sharing Agreement.

Type and Quantity of Indigenous Biological Resources

This Agreement concerns the following indigenous biological resources (specify below type of resources, quantity of resources and area or source from which the resources are to be collected or obtained)

Current uses of indigenous biological resources

The present potential uses of the indigenous biological resources to be collected are the following: __________________________________________________________________ __________________________________________________________________

Intended use of indigenous biological resources

The manner in which, and the extent to which, the indigenous biological resources are to be used or exploited for purposes of the bioprospecting are (insert details): __________________________________________________________________ __________________________________________________________________

Traditional use or knowledge (if applicable)

The indigenous community that is a party to this Agreement has the following traditional knowledge of the indigenous biological resources or has traditionally used the indigenous biological resources in the following way: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

Sharing in Benefits

Benefits will vary considerably from case to case and in particular, benefits will vary depending on whether the stakeholder is providing access to the indigenous biological resources, or is an indigenous community. The lists below provide examples of monetary and non-monetary benefits that may arise from bioprospecting projects. This first list is more relevant if the stakeholder to this Agreement is providing or giving access to the indigenous biological resources, while the second list is more relevant if the stakeholder to this Agreement is an indigenous community. Tick each block that applies to this agreement and identify below who will be the beneficiary of each benefit and the extent of the benefit (provide supporting documentation where necessary).

To be completed if stakeholder is providing or giving access to the indigenous biological resources

__________________________________________________________________

To be completed if stakeholder is an indigenous community

Payment of Benefits

All money arising out of this Agreement and due to any party to this Agreement must be paid into the Bioprospecting Trust Fund. The Trust Fund will in turn provide details in terms who benefits from the fund, how payments will be calculated and made to the beneficiaries. This information may form part of the Annexure to this Agreement. Please note that implementation of this Clause will vary from country to country and will be guided by the relevant legislation, where it exists.

Duration of the Agreement

This Agreement shall operate as from the date of signature hereof and shall remain binding for a period of ____ (________________) years, unless terminated prior thereto by mutual written consent between the parties or superseded by another written agreement between the parties in the field.

Review of the Agreement

This Agreement will be reviewed every ____________ (insert agreed time frame), with a view to amending the Agreement if necessary. ____________(insert period in days or months) prior to every review, the permit holder must disclose any new material information with regard to the bioprospecting to all stakeholders to enable stakeholders to participate in the review from an informed basis.

Other Matters

Any other matters or conditions which the parties to this Agreement wish to record may be attached to this Agreement as an annexure.

A copy of this Agreement must be lodged with ______________________(insert authority responsible) within __________________________(insert period in days or months) of the Agreement being concluded.

This Agreement constitutes the entire agreement between the parties with regard to the subject matter of this Agreement and no addition to, variation or cancellation of this Agreement or waiver of any rights under this Agreement will be of any force or effect, unless reduced to writing and signed by the parties to this Agreement.

Signature of applicant for permit: _______________________________________ Date: _________________________________
Capacity of signatory: ____________________________________
On behalf of: ___________________________________________

Endorsement of a juristic body, (if applicable)
Name of juristic body: ________________________________________________ Signature of duly authorized offi cer from the juristic body: __________________
Date: _________________________________

Signature of access provider of indigenous biological resource: _______________
Date: _________________________________
Capacity of signatory: ____________________________________________
On behalf of: ____________________________________________________

Signature of indigenous community representative: _____________________ Date: _________________________________
Capacity of signatory: ______________________________________________
On behalf of: _____________________________________________________ Approved by: _____________________________________________________ Signature: _____________________________
Date: _________________________________

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