[별지 제12-1호서식]

NO. :

[ ] Domestic

Approval for Distribution of Genetic Resources

[ ] Overseas

Applicant

Organization

Business Registration No.

Name(Representative)

(Last, First, Middle)

Date of Birth

Residence Address

Tel.

Office Address

Tel.

Resources Approved to be Distributed

(Additional papers can be attached, if needed)

Serial No.

Resources No.

Common Name(Scientific Name)

Name of Resources

Distribution Quantity

Terms of Distribution :

Under the Article 16 Clause 1 of The Law for ConservationㆍManagement and Use of Genetic Resources of Agriculture and Fisheries and Article 7 Clause 2 of enforcement ordinance of the same law, the genetic resources requested above are hereby approved to be distributed.

year         month       date

Natiional Academy of Agricultural Science	seal

210mm×297mm[백상지 120g/㎡]