[별지 제10-1호서식]

Korean Agricultural Culture Collection (KACC) National Academy of Agricultural Science, RDA Tel. 063-238-3024, Fax. 063-238-3834. Homepage http://genebank.go.kr

Acceptance of Responsibility for Potentially Pathogenic Materials

Ordering ID: Ordering date :	Name: Institute: Address:

KACC has designated certain strains as human, animal or plant pathogens to alert the user to potential risk. Your order contains such strain(s).

	Scientific name	KACC No.	Risk group
1
～

In order to receive above cultures, this form must be completed and returned to KACC by Fax (82-63-238-3834) or post, before shipment of the following culture(s):

I recognize that the material listed above represents a potential hazard to the public health and/or agriculture. I testify that the investigators concerned are qualified through education and training to work with such material. I hereby assume all risks and responsibility in connection with the receipt, storage, handling and use of this material. It will not be distributed to third parties ."

Institute :

Address :

Telephone :                          Fax:

Applicant :                          Signature

Date :