■ 유전자원의 접근ㆍ이용 및 이익 공유에 관한 법률 시행규칙 [별지 제4호의2서식] <신설 2018. 12. 27.>

Serial No.

Verification Certificate for the Conclusion of

Mutually Agreed Terms

Serial Number of Declaration

Certificate for Access to Domestic Genetic Resources

Applicant

Name

(The Corporate Representative)

Affiliation

(The

Corporate Name)

Date of Birth

(The

Corporation

Registration

Number)

Contact

Number

(Phone)

(Email)

Mutually

Agreed

Terms

Concluded

This Verification Certificate for the Conclusion of Mutually Agreed Terms is issued in accordance with the latter part of Article 4(4) of the Enforcement Decree of the Act on Access to and Utilization of Genetic Resources and Benefit-Sharing and Article 3(4) of the Enforcement Rule thereof.

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

Head of Competent National Authority	Seal

210mm×297mm[백상지(120g/㎡)]