Proforma for submitting application to IBSC/RCGM for permission to Import/ Exchange of GMOs/ LMOs and products thereof for Research and Development Purposes

 

 

 

1.  

 

Name of the Applicant

 

 

 

Designation

 

 

 

(a) Address (Registered Office)

 

 

 

Telephone No.

 

 

 

Telex No.

 

 

 

Fax No.

 

 

 

e-mail

 

 

 

 

 

 

 

(b) Address (Research Station)

 

 

 

Telephone No.

 

 

 

Telex No.

 

 

 

Fax No.

 

 

 

e-mail

 

 

 

 

 

2. 

 

Application for (to indicate the purpose) :

 

 

 

 

 

3. 

 

Description of the GMOs/ LMOs/ product thereof (in scientific terms in narrative manner providing information on (a) Morphology; (b) Number of copies of the gene incorporated;

 

 

 

 

(c) Status of approval is country of origin)

 

4.

 

 

 

 

 

 

 

 

 

 

5.

 

 

6.

 

 

 

 

 

 

 

 

7.

  

 

 

 

 

 

 

 

 

 

 

 

 

Source of GMOs/ LMOs Products thereof:

 

Name of the Agency

Contact person's

Address

Telephone No.

Telex No.

Fax No.

e-mail

 

 

Quantity of GMOs/ LMOs/ products thereof to be

Imported/ exchanged:

 

Details on:

(a)      Source of nucleic acid(s) :

(b)     Nucleic acid sequence (Please enclose the nucleic acid sequence map of the target gene) :

(c)       Vector(s) (Please enclose the map of the vector):

(d)      Sequence of the genes incorporated/ to be incorporated into the host organism.

(e)      Host(s) that carrying the vector(s)/ target gene(s) :

(f)        Manipulative procedures in outline :

 

 

Objectives of the proposal:

 

 

8.

 

 

 

9. 

 

Summary of the proposed work plant utilizing GMOs/ LMOs/ products thereof:

(This should indicate schematic lab work, green house whenever applicable)

 

 

Mode of shipment :

 

 

 

 

 

10.

 

 

 

11.

 

 

 

Information on containment facilities installed at R&D and production premises

(whichever is applicable)

 

 

Standard Operating Procedures (SOP) on decontamination, disposal mechanisms & risk management (in brief) :

 

 

 

 

 

12. 

 

Any other relevant points(s)

 

 

13. 

 

 

Declaration :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I declare that the information provided in the above format is correct and accurate to the best of my knowledge. The "Biosafety Guidelines" brought out by the Department of Biotechnology, Ministry of Science & Technology, Govt. of India will be and is being strictly followed. The imported/ exchanged material will be utilized for the said purpose only. In case any untoward incident occurs, the Chairman of the IBSC and the Member-Secretary of the RCGM will be informed immediately.

 

 

Place:

 

Date:                                                                      Signature of the Applicant

 

 

 

14.

 

 

 

Recommendations:

 

 

The proposal set out above has been considered by the “Institutional Biosafety Committee” in its meeting held on __________________ and is forwarded and recommended to RCGM for further necessary action.

 

 

Place:

 

Date:                                                                     Signature of the Chairman, IBSC

 

 

 

 

(Note: Please submit 20 copies of the application to the Department of Biotechnology for placing the same in the meeting of RCGM)