■ 유전자원의 접근ㆍ이용 및 이익 공유에 관한 법률 시행규칙 [별지 제6호의2서식] <신설 2018. 12. 27.>
Procedural Compliance Report on Foreign 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: 5 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)
Provider of Genetic Resources	⑥ Name(The Corporate Representative)	⑦ Affiliation(The Corporate Name)
⑧ Name of the Providing Country	⑨ Contact Number (Phone) (Email)
⑩ Address(The Location of Its Place of Business)
Prior Informed Consent	The Country Granting the Prior Informed Consent	The Institution Granting the Prior Informed Consent	Consent Number	Date of Consent
Genetic Resources and Utilization	⑪ Name of the Foreign Genetic Resources(Common name and scientific name of the relevant species) ( / )	⑫ Quantity or Concentration ([ ] Traditional Knowledge)
⑬ Purpose for Accessing the Genetic Resources [ ] Commercial [ ] Non-commercial	⑭ Purpose for Utilizing the Foreign Genetic Resources [ ] Pharmaceutical [ ] Cosmetics [ ] Horticulture [ ] Miscellaneous ( )
⑮ Whether the Mutually Agreed Terms are Concluded [ ] Yes [ ] No	⑯ If not, reasons for Not Concluding
⑰ Contents of Mutually Agreed Terms [ ] Monetary Benefit Sharing [ ] Non-monetary Benefit Sharing [ ] Conditions for Later Use by Third-Party [ ] Conditions for Changes in Use [ ] Conditions for Reporting or Information Sharing Between Provider and User [ ] Applicable Jurisdiction, Governing Law of Dispute Settlement Procedure, and Alternative Dispute Resolution (Mediation, arbitration, etc.) [ ] Miscellaneous ( )
I hereby submit this Procedural Compliance Report on Foreign Genetic Resources pursuant to Article 15(1) of the Act on Access to and Utilization of Genetic Resources and Benefit-Sharing, Article 6 of the Enforcement Decree thereof, and Article 5 of the Enforcement Rules thereof.
[Month] [Day] [Year] . . .
The Reporting Person (Sign or Seal)
To: Head of National Checkpoint
Documents to be Submitted by Applicant	1. One Document to demonstrate that he/she has been approved for access to genetic resources from a country providing relevant genetic resources 2. A copy of Mutually Agreed Terms (if concluded) 3. Certified copies of resident registration cards, or foreigner registration certificates (Only if the National Checkpoint cannot verify the identification or affiliation of the reporting person by sharing administrative information)	No Fee
Matters to be Checked by the Head of National Checkpoint	1. Corporation Registration Certificates (in cases of corporations) 2. Certified copies of resident registration cards, or foreigner registration certificates (in cases of individuals)
210mm×297mm[백상지(80g/㎡) 또는 중질지(80g/㎡)]

(Back)

Consent to Sharing Administrative Information

I hereby consent that officers in charge of reporting can check matters to be checked above by the Head of National Checkpoint through sharing administrative information pursuant to Article 36(1) of Electronic Government Act

※ If the reporting person does not consent to the above, the applicant must submit the relevant document directly.

The Reporting Person

(Sign or Seal)

Instructions

1. 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

2. If the provider is a corporation, please state the name of corporate representative in column ⑥; the corporate name in column ⑦; the corporation registration number in column ⑧; and the location of its place of business in column ⑩.

3. Where the name of a certain genetic resource exists, please state such name in column ⑪ Name of the Foreign Genetic Resources, along with the scientific name and the common name of the relevant species. If no name of a certain genetic resource exists, then please state only the scientific name and common name of the relevant species.

4. If the reporting person intend to access to genetic resources, please state quantity or concentration of the genetic resources in column ⑫ and if the person intend to access to traditional knowledge, then it should be ticked.

5. Multiple ticks are permitted in columns ⑬ Purpose for Accessing the Genetic Resources and ⑭ Purpose for Utilizing the Foreign Genetic Resources

6. If you have not concluded an agreement on sharing benefits with the providers, please briefly state the reasons as to why no Mutually Agreed Terms were concluded, in column ⑯.

7. Multiple ticks are permitted in column ⑰ if Mutually Agreed Terms are concluded; and if the relevant details exist in Mutually Agreed Terms, then they should be ticked.

Administrative Process

Completing Form	□	Receiving Form	□	Reviewing Form	□	Completion