APPLICATION TO USE AN EXISTING IBSC APPROVAL
TO DEVELOP A LOW RISK GENETICALLY MODIFIED ORGANISM
IN CONTAINMENT
Name of Applicant:
(Staff Member only)
Name of Institute/Department/School:
Extension Number:
Application Number of Existing Approval:
Title of Existing IBSC Approval:
Where will the new work using this existing IBSC approval be conducted?
Where will the new material generated using this existing IBSC approval be stored?
Brief Description of Project in Lay Terms:
(Explain how the new work fits under the existing project and justify in terms of the short summary of purpose (or
summary of application, 2012 onwards) as described in the original application)
BACKGROUND
(optional)
WHAT
WHY
HOW
JUSTIFY
(Why must this
work use GM
techniques?
Why is project
important?)
PROJECT
SCOPE
(Host/Donor
restrictions
- if applicable)
Organism Description Table:
Name of the
organism and
taxonomic
authority:
If more than
one, please list
as shown in the
example within
the internal
cover sheet
Specify the
category of host
organism (e.g.
category 1 or 2)
as outlined in the
new HSNO LowRisk Genetic
Modification
Regulations 2003
What the
organism is
modified with:
Please specify
vector and donor
DNA.
If host is a
micro-organism
in category 2,
please also state
if it is risk group
1 or 2
Category
requirements
(e.g. Category
B) as outlined in
the new HSNO
Low-Risk Genetic
Modification
Regulations 2003
Containment
level (e.g. PC1,
PC2) as in the
AS/NZS Standard
2243.3 2002
Safety in
Laboratories Pt 3:
Microbiological
aspects and
containment
facilities
The applicant agrees to use this existing IBSC approval for the purpose outlined and hereby:
(1)
(2)
certifies that the proposed work falls within the purpose of the existing IBSC
approval, and
agrees to accept the conditions and comply with the controls listed in the associated
IBSC-approved decision form.
_____________________________________
Signature of Applicant
____________________
Date
Please print, sign and date one copy of this form, append it to a copy of the IBSC-approved
decision form of the existing approval, and forward both documents to:
The Secretary
Genetic Technology Committee
Research Ethics Office
Room 1.25
Courtyard Complex
Turitea PN221
OFFICE USE ONLY
Permission Statement:
The Massey University Genetic Technology Committee hereby grants approval to:
_________________________________________________________ (name of applicant)
to use the existing IBSC approval number GMO_______________ for the purpose outlined.
_____________________________________
Chairperson
____________________
Date