SPANISH TYPE CULTURE COLLECTION (CECT) Parc Científic Universitat de València Catedrático Agustín Escardino, 9 46980 Paterna (Valencia) Tel: +34 96 354 4612 www.cect.org ACCESSION FORM FOR PUBLIC DEPOSIT OF STRAINS Type of microorganism: Bacteria Archaea Fungi Yeast To be completed by the CECT CECT accession number: Date culture received: Strain designation *Scientific name (or proposed): *Strain designation used by the depositor: Is the strain to be deposited type strain of the species / subspecies? YES NO Origin of the strain *Isolated by (person and date): *Source of isolation: Information relating to the Convention on Biological Diversity (CBD – http://www.biodiv.org/) *Country of origin and/or geographical location: No organism can be accepted without this information When applicable: Sampling agreement (Prior Informed Consent or PIC) Name and address of the person or organization who issued the PIC Please attach documents If you did not isolate the strain, please indicate the sequence of scientists or laboratories which maintained it before you depositor < < < Cultivation of the strain *Culture media (no. CECT or composition): *Incubation temperature: *Incubation time: *Metabolism: aerobic facultative anaerobe microaerophilic obligate anaerobe *Special requirements (light, gas phases, etc) Does this microorganism survive freezing? Fields marked with an asterisk (*) are compulsory YES Ed_05_201410724 NO Additional data Methods used for strain identification Please attach reprint or supply strain specific data Reasons for deposit (biotechnological applications, quality control, etc) Does the microorganism harbour a natural plasmid? (If so, fill in annex 1A) YES NO Is the microorganism genetically manipulated? (If so, fill in annex 1B) YES NO RISK ASSESSMENT In agreement to Spanish regulations (RD 664/1997), depositors are requested to provide information about risk assessment of the strain. The CECT accepts risk group 1, 2 and 3(*) strains. Risk group: Pathogenic for: □ □ group 1 animals □ □ group 2 □ plants specify: group 3(*) IMPORTANT: 1. Information regarding public deposits that are pending of taxonomic description will be kept confidential until description is published or until the depositor authorizes the publication in the open catalogue. If the information is not published after 4 years from the deposit, the CECT reserves the right to release the strain to the public catalogue. 2. According to the CBD (Convention on Biological Diversity), is the depositor responsibility to ensure that the samples from which the strains were isolated, were collected according to the legislation of the country of origin and that the deposit of the strains in an open collection does not infringe any national regulation. NOTE: The undersigned certifies that the information provided on this form is true and agrees that subcultures of the deposited strain are distributed by the CECT for a fee to cover preservation and distribution expenses, in agreement with the CECT Material Transfer Agreement (MTA) Depositor *Name: *Institution Address: *Email: Telephone: Fax: * Date: * Signature: Fields marked with an asterisk (*) are compulsory Ed_05_201410724 ANNEX I A. Fill only if the microorganism harbors a natural plasmid Plasmid data, if the strain is known to harbour a natural plasmid Plasmid designation: Natural host: Molecular weight of plasmid: Plasmid isolated by (references): Is the plasmid self-transmissible? YES NO Genetic properties of the plasmid (R: resistances, etc): Unique restriction sites (please include map or reference): B. Fill only if the microorganism if genetically manipulated Please, attach reprints or complete as far as possible In agreement to Spanish regulations (RD 15/1994) concerning genetic engineering, depositors are requested to provide information about: Data concerning the host organism: Risk group: Pathogenic for: □ □ group 1 animals □ □ group 2 □ plants specify: group 3(*) Sensitivities Resistances Auxotrophies Special properties (restriction/modification system, genetic recombination, etc): Data concerning the donor organism: Risk group: Pathogenic for: □ □ group 1 animals □ □ group 2 □ plants specify: group 3(*) Description of the cloned DNA fragment (please, attach reprints or complete as far as possible): Size of the cloned DNA (in bp): □ complete genome □ subgenomic Fields marked with an asterisk (*) are compulsory □ subgenic Ed_05_201410724