BELGIAN COORDINATED COLLECTIONS OF MICROORGANISMS
BCCM/MUCL-COLLECTION

Form BCCM/MUCL/BP/3/................ Statement in the case of a new deposit with another IDA

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 a new deposit with another International Depositary Authority pursuant to Rule 6.2

Form BCCM/MUCL/BP/3/................ (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 makes a new deposit under Article 4 of the Budapest Treaty and confirms his undertaking 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.1 above has the following properties which are or may be dangerous to health or the environment:






The undersigned is not aware of such properties.

The host organism identified under I.2 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. International Depositary Authority with which the previous deposit was made:

VII.1 Name:

VII.2 Address:

VIII. Accession number given to the previous deposit:

IX. Reason for making a new deposit.

The international depositary authority with which the previous deposit was made has ceased to have the status of international depositary authority or has discontinued the performance of its function, and the microorganism has not been transferred to another international depositary authority which is in a position to furnish samples thereof.

Date of receipt of the notification referred to in Article 4(1)(a):

Date of the publication referred to in Article 4(1)(e):

The sending or receipt of samples of the microorganism which was the subject of the previous deposit is prevented:

by export restrictions

or

by import restrictions

Date of receipt of the notification referred to in Article 4(1)(a):

X. Statement under Article 4(1)(c)

The undersigned hereby alleges that the microorganism identified under I above is the same as that which was the subject of the previous deposit.

XI. Most recent scientific description indicated in connection with the previous deposit:

Not to be filled in if no scientific description has been indicated in connection with the previous deposit.

Use form BCCM/MUCL/BP/7 if, when making the new deposit, it is desired to furnish for the first time or amend a scientific description.

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

XI.1 Scientific description:






XI.2 Proposed taxonomic designation:






XII. Furnishing of samples:

The undersigned

requests

does not request

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:

Enclosures:

Copy of the receipt of the previous deposit
Copy of the most recent statement concerning the viability of the microorganism which was the subject of the previous deposit indicating that the microorganism is viable