■ 유전자원의 접근ㆍ이용 및 이익 공유에 관한 법률 시행규칙 [별지 제5호의2서식] <신설 2018. 12. 27.>
Change Report on Access to Domestic Genetic Resources
※ Please read the instructions on the reverse side and place a √ in the applicable [ ]								(Front)
Registration No.			Registration Date and Time				Processing Period: 30 days
Reporting Person	① Name (The Corporate Representative)			② Affiliation (The Corporate Name)
	③ Date of Birth (The Corporation Registration Number)			④ Contact Number (Phone) (Email)
	⑤ Address(The Location of Its Place of Business)
Serial Number of Declaration Certificate for Access to Domestic Genetic Resources to be Changed
Contents of Changes
Category			Before Changes			After Changes
[ ] To Change Purpose for Accessing or Utilizing the Declared Genetic Resources
[ ] To Increase in Quantity or Concentration of the Declared Genetic Resources
[ ] To Change the Details of Mutually Agreed Terms Concerning the Relevant Genetic Resources
I hereby submit this Change Report on Access to Domestic Genetic Resources, as above, in accordance with Article 9(3) of the Act on Access to and Utilization of Genetic Resources and Benefit-Sharing, Article 4(6) of the Enforcement Decree thereof and Article 4 of the Enforcement Rules thereof.
[Month] [Day] [Year] . . .
The Reporting Person (Sign or Seal)
To: Head of Competent National Authority
Documents to be submitted by Applicant		1. Declaration Certificate for Access to Domestic Genetic Resources 2. A copy of Mutually Agreed Terms(If amended)							Fee: KRW 5,000
210mm×297mm[백상지(80g/㎡) 또는 중질지(80g/㎡)]

(Back)

Instructions

1. The reporting person does not have to state the shaded columns.

2. If the reporting person is a corporation, please state the name of corporate representative in column ①; the corporate name in column ②; the corporation registration number in column ③; and the location of its place of business in column ⑤.

Administrative Process

Completing Form	□	Receiving Form	□	Reviewing Form	□	Reviewing Acceptance	□	Making a Decision	□	Issuing a Certificate