BELGIAN COORDINATED COLLECTIONS OF MICROORGANISMS
BCCM/MUCL-COLLECTION
Form BCCM/MUCL/BP/1/................ Statement in the case of an original deposit

Budapest Treaty of 28 April 1977 on the International Recognition of the Deposit of Microorganisms for the Purposes of Patent Procedure.

Statement in the case of an original deposit pursuant to Rule 6.1

Form BCCM/MUCL/BP/1/................ (number to be filled in by IDA)

(General remark: Always mark the applicable (or boxes) with a cross)

Send to:
Belgian Coordinated Collections of Microorganisms (BCCM)
Mycothèque de l'Université Catholique de Louvain (MUCL)
Place Croix du Sud 3
B-1348 Louvain-la-Neuve, Belgium

The undersigned hereby deposits under the Budapest Treaty the microorganism identified hereunder and undertakes not to withdraw the deposit for the period specified in Rule 9.1

I. Identification of the microorganism:

I.1 dentification reference:

(Number, symbols, etc. given to the microorganism by the depositor)






I.2 Is this a mixture of microorganisms ?

Yes - No

II. Conditions for cultivation:
Is additional information given on a attached sheet ? Yes - No








III. Conditions for storage:
Is additional information given on a attached sheet ? Yes - No








IV. Conditions for testing viability:
Is additional information given on a attached sheet ? Yes - No








V. Components of mixture: (in case the answer to I.2 is "Yes")
Is additional information given on a attached sheet ? Yes - No

V.1 Description of components:






V.2 Method(s) for checking presence of components:






VI. Properties dangerous to health or environment:
Is additional information given on an attached sheet ? Yes - No

The microorganism identified under I above has the following properties which are or may be dangerous to health or the environment:






The undersigned is not aware of such properties.

VII. Scientific description and/or proposed taxonomic designation:

It is strongly recommended that the scientific description and/or proposed taxonomic designation of the microorganism be indicated.

Is additional information given on an attached sheet ? Yes - No

VII.1 Scientific description:






VII.2 Proposed taxonomic designation:






VIII. Additional data: (optional)

- the source of the microorganism;
- the name(s) and address(es) of any other depositary institution(s) with which the microorganism has been deposited;
- the criterion used when drafting the proposed taxonomic designation.

Is additional information given on an attached sheet ? Yes - No

IX. If the depositor is a legal entity and if official notifications should not be sent to the address given in point XII, then indicate name and address of the person to whom official notifications should be sent:

Name :

Address :

X. If the depositor has a patent agent:

Will this patent agent handle all communications with BCCM/MUCL instead of the depositor ?
Yes - No

Should BCCM/MUCL send the patent agent a copy of the official receipt and viability statement ?
Yes - No

Name:

Address:

XI. Furnishing of samples:

The undersigned
does not request
requests

to be notified in writing of the fact that a sample of his microorganism has been furnished to any interested party other than the depositor, as stated in Rule 11.4(g).

XII. Depositor:

Name:

Address:

Signature:

(Where the signature is required on behalf of a legal entity, the typewritten name(s) of the natural person(s) signing on behalf of the legal entity should accompany the signature(s)).

Date: