インド生物資源伝統的知識第三者移転許可申請FORM IV

Application form for seeking approval of National Biodiversity Authority for third party transfer of the accessed Biological resources and associated traditional knowledge.

1. Full particulars of the applicant
　i.Name
　ii.Address:
　iii.Professional profile
　iv.Organizational affiliation (Please attach relevant documents of authentication):

2. Details of the biological material and traditional knowledge accessed.

3. Details of the access contract entered (Copy to be enclosed)

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

5. Full particulars of the third part to whom the accessed material / 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 India/ communities arising out of the third party transfer of accessed biological resources and 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.

Signed

Place

Name

Date

Title

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