■ 유전자원의 접근ㆍ이용 및 이익 공유에 관한 법률 시행규칙 [별지 제2호의2서식] <신설 2018. 12. 27.>

(Front)

Serial No.

Declaration Certificate for Access to

Domestic Genetic Resources

The Reporting Person

Name

(The Corporate

Representative)

Affiliation

(The Corporate

Name)

Date of Birth

(The Corporate

Registration Number)

Contact Number

(Phone)

(Email)

Provider

of

Genetic

Resources

Name

(The Corporate

Representative)

Affiliation

(The Corporate

Name)

Date of Birth

(The Corporate

Registration Number)

Contact Number

(Phone)

(Email)

Contents of Report on Access to Domestic Genetic Resources

Name of

the Genetic Resources

Quantity or

Concentration

Methods for

Accessing

the Relevant

Genetic Resources

Access to Genetic Resources through Third-Party

(Affiliation)

(Name)

(Contact Number)

Purpose for

Accessing Genetic Resources

[  ] Commercial

[   ] Non-commercial

Purpose for

Utilization

Country

Seeking to Utilize the Relevant

Genetic Resources

Whether Mutually Agreed Terms are Concluded

[  ] Yes   [  ] No

Period of

Utilization

This Declaration Certificate for Access to Domestic Genetic Resources is issued regarding the above details in accordance with Article 4(3) of the Enforcement Decree of the Act on Access to and Utilization of Genetic Resources and Benefit-Sharing and Article 3(2) of the Enforcement Rule thereof.

[Month] [Day] [Year]            .      .        .

Head of Competent National Authority	Seal

210mm×297mm[백상지(120g/㎡)]

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