Institutional Animal Care and Use Committee
Reg. No. 200604393R
Animals Transfer Agreement Form
Please use this form for transferring animals between investigators and/or protocols if same
investigator.
Submit to: IACUC Secretariat, Ms Lee Shok Li (Email: iacuc@ntu.edu.sg)
A
PROVIDER’S INFORMATION
Name of Provider:
Name of PI (in FULL):
Provider’s Email:
IACUC Protocol No.:
B
RECIPIENT’S INFORMATION
Name of Recipient:
Name of PI (in FULL):
Recipient’s Email:
IACUC Protocol No.:
Will this transfer exceed the approved number of animals in the above protocol?
*Yes
No
Please attach the Animal Use Protocol Minor Amendment form. This transfer will be subjected to the
IACUC’s approval.
C
TRANSFER INFORMATION
Date of Transfer:
Reason(s) for Transfer:
Location of animals
currently (Level/Room):
Location where animals will
be housed (Level/Room):
All fields are compulsory. Please attach a sheet if the space provided is insufficient.
No. of
No. of
Age
Prior Procedures Done
No.
Species
Strain
Genotype
Males
Females
(weeks)
on Animal(s)
Version: IACUC_ANIMALTRANSFER_V01
Created by: Lee Shok Li
Last updated: 29 August 2014
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Institutional Animal Care and Use Committee
Reg. No. 200604393R
C
Terms and Conditions
1. All transfers will only be acknowledged via email submission.
2. This Animals Transfer Agreement Form should be submitted at least 1 week in advance of the
estimated date that the animals are transferred.
3. The animal(s) stated in this form must only be used within the University.
4. The recipient accepts full ownership and control of the animal(s).
5. Any prior procedures done, surgical or non-surgical, must be declared in this form.
6. The procedures done on the transferred animals must be done in accordance to the recipient’s protocol.
7. All requisitions are subjected to the facility management’s approval and/or the IACUC’s approval before
the transfer.
8. Recipient must ensure that there is sufficient cage space within the allocated rack(s) to house the
animal(s) to be transferred.
We are agreeable to the terms and conditions stated on this requisition form and will abide by them.
*Signature of Provider
Date
*Signature of Recipient
Date
OFFICIAL USE ONLY
Approve / Reject
*Signature of Facility Manager
Version: IACUC_ANIMALTRANSFER_V01
Created by: Lee Shok Li
Last updated: 29 August 2014
Date
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