DECLARATION

I/We declare the information provided in the application form is true and correct and I/ We shall be responsible for any incorrect/wrong information.

Signed

Name

Title

Place: ......................

Date: .......................

FORM IV

(See rule 19)

APPLICATION FORM FOR SEEKING APPROVAL OF NATIONAL BIODIVERSITY AUTHORITY FOR THIRD PARTY TRANSFER OF THE ACCESSED BIOLOGICAL RESOURCES AND ASSOCIATED TRADITIONAL KNOWLEDGE