Supplementary Form D:
Non-Commercial – Conservation Breeding or Propagation
This form should be completed if you ticked
the ‘Non-commercial - Conservation Breeding
or Propagation’ box in answer to the purpose
of export/ import question in the Permit
Application form. If so, please complete this
form and return it, along with the Permit
Application form, to the Department of
Sustainability, Environment, Water, Population
and Communities.
2. Have you previously received an
import/export permit under Part 13A of the
Environment Protection and Biodiversity
Conservation Act 1999 for the same taxon?
No
Go to next question
Yes
Include previous import/export
permit numbers below and go to
next question
Information on the requirements for approval
of permits for the purpose of conservation
breeding or propagation is available at
http://www.environment.gov.au/biodiversity/wil
dlife-trade/sources/non-commercial/index.html
Applications that are incomplete or contain
insufficient information cannot be assessed.
Delays will occur whilst further information is
sought from the applicant.
3. Is the import/export of the specimens covered by a
Cooperative Conservation Program approved by
the Department?
If there is insufficient space on this form to
fully address any of the questions please
attach additional pages.
The list of approved Cooperative Conservation
programs is available at
http://www.environment.gov.au/biodiversity/wil
dlife-trade/sources/noncommercial/ccp/register.html
1. Title of conservation breeding/propagation
No
A permit cannot be issued at this
stage, but you may apply to have a
program approved.
Information and application forms
for applying for approval of a cooperative conservation program is
available at
http://www.environment.gov.au/bio
diversity/wildlife-trade/sources/noncommercial/ccp/index.html
Yes
Name of Cooperative Conservation
Program
program
Go to next question
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4. Is the specimen needed for conservation
6. Is there currently in place an Ambassador
breeding or propagation by the exporting
country?
Agreement between the exporting and
importing institutions and the Department
relating to the species?
Include a statement on how it was
determined that the exporting country does
not require the specimens (if necessary on
a separate page).
No
For example, relevant census or plan
prepared by a regional zoological
association does not list any institution in
the exporting country as desiring the
species for conservation breeding.
No
Go to next question
Yes
Include date agreement came
into effect (date signed by the
Department)
Go to question 8
7. Are the exporting and importing
institutions prepared to enter into an
Ambassador Agreement with each other
and the Department for the species to be
exhibited?
Go to next question
Approval of your application will not
be possible. (The regulations require
that specimen is not needed for
conservation breeding or propagation
by the exporting country.)
Yes
5. Is the application for the export of a live koala,
platypus, wombat, Tasmanian devil or a
species listed as threatened (excluding the
Conservation Dependent category) under
section 178 of the EPBC Act.
The list of EPBC threatened species is at
http://www.environment.gov.au/biodiversit
y/threatened/
No
The issue of a permit will
not be possible
Yes
Applicant should contact the
Department, to get a copy of
the standard Ambassador
Agreement. The application
can be submitted to the
Department prior to the
agreement being signed, but a
permit cannot be issued until
the Agreement has been
signed by all Parties.
8. Attach copies of any other approvals
or permits relating to the specimens
Include (where appropriate):
Ethics committee approvals
State/Territory holding, collection, import and
export permits
CITES permits
No
Go to question 8
Yes
The exporter, importer and the
Department must enter into an
agreement (Ambassador
Agreement) about the treatment
and disposal of the animal and
any progeny of the animal.
Go to next question
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9. Declaration
I declare that I/my organisation
a)will ensure that the specimen or its
progeny will only be removed from
the co-operative conservation
program in accordance with the
program’s objectives; and
b)will not allow a specimen, used in the
program, to be used for commercial
purposes.
Name of recipient or authorised person
(if applicant is an organisation)
Position within organisation (if applicable)
Organisation (if applicable)
Signature of recipient or authorised
person
Date signed
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