STATEMENT IN THE CASE OF AN ORIGINAL DEPOSIT
PURSUANT TO RULE 6.1.
BCCM/LMG/BP/1
F415C
14/01/2014
Page 1 of 4
BUDAPEST TREATY ON THE INTERNATIONAL RECOGNITION OF THE DEPOSIT OF
MICRO-ORGANISMS FOR THE PURPOSES OF PATENT PROCEDURE
To:
Belgian Coordinated Collections of Micro-organisms (BCCM)
Laboratorium voor Microbiologie – Bacteriënverzameling (LMG)
Universiteit Gent
K.L. Ledeganckstraat 35
9000 Gent
Belgium
Form
BCCM/LMG/BP/1/
.....
(number to be filled in by
IDA)
The undersigned hereby deposits under the Budapest Treaty the micro-organism identified hereunder and
undertakes not to withdraw the deposit for the period specified in Rule 9.1.1
I. IDENTIFICATION OF THE MICRO-ORGANISM
Identification reference (number, symbols, etc.,
given to the micro-organism by the depositor):
Is this a mixture of micro-organisms?
Yes
II. CONDITIONS FOR CULTIVATION
No
MARK WITH A CROSS IF ADDITIONAL INFORMATION IS GIVEN ON
AN ATTACHED SHEET
Recommended growth conditions (as attachment if necessary):
Medium (composition or reference):
Incubation temperature:
Light requirements:
Oxygen relationship:
Special gas requirements:
Other requirements:
III. CONDITIONS FOR STORAGE
MARK WITH A CROSS IF ADDITIONAL INFORMATION IS GIVEN ON
AN ATTACHED SHEET
Applicable preservation methods:
Lyophilisation
Cryopreservation
Other:
Recommended conditions (suspending fluid, cryoprotectans, cooling rate, etc.):
1
This form may also be used if the undersigned converts a deposit of a micro-organism that he or his predecessor in title has already
deposited outside the Budapest Treaty to a deposit under the Budapest Treaty, with the same depositary institution either before (Rule
6.4.(d)) or after the acquisition by that institution of the status of international depositary authority.
STATEMENT IN THE CASE OF AN ORIGINAL DEPOSIT
PURSUANT TO RULE 6.1.
BCCM/LMG/BP/1
IV. CONDITIONS FOR TESTING VIABILITY
V. COMPONENTS OF THE MIXTURE (IF APPLICABLE)
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MARK WITH A CROSS IF ADDITIONAL INFORMATION IS GIVEN ON AN
ATTACHED SHEET
MARK WITH A CROSS IF ADDITIONAL INFORMATION IS GIVEN ON AN
ATTACHED SHEET
Description of components:
Method(s) for checking presence of components:
VI. PROPERTIES DANGEROUS TO HEALTH OR
MARK WITH A CROSS IF ADDITIONAL INFORMATION IS GIVEN ON AN
ENVIRONMENT
ATTACHED SHEET
The micro-organism identified under section I above has the following properties which are or may be
dangerous to health or the environment:
Hazardous to humans?
Yes, risk group:
No
Not aware of such properties
Hazardous to animals?
Yes, risk group:
No
Not aware of such properties
Hazardous to plants?
Yes, risk group:
No
Not aware of such properties
Disease name and symptoms:
The strain has been genetically modified:
Yes
No
If yes, provide biosafety details (parent strain, donor organism of the DNA):
VII. SCIENTIFIC DESCRIPTION AND/OR PROPOSED
MARK WITH A CROSS IF ADDITIONAL INFORMATION IS GIVEN ON AN
TAXONOMIC DESIGNATION2
ATTACHED SHEET
Scientific description (specific properties of the strain):
Proposed taxonomic designation (genus and/or species name):
2
It is strongly recommended that the scientific description and/or proposed taxonomic designation of the micro-organism be indicated.
STATEMENT IN THE CASE OF AN ORIGINAL DEPOSIT
PURSUANT TO RULE 6.1.
BCCM/LMG/BP/1
VIII. ADDITIONAL DATA3
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14/01/2014
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MARK WITH A CROSS IF ADDITIONAL INFORMATION IS GIVEN ON AN
ATTACHED SHEET
IX. F U R N I S H I N G O F S AM P L E S
The undersigned requests to be notified in writing of the fact that a sample of his micro-organism has been
furnished to any interested party other than the depositor, as stated in Rule 11.4.(g).
Yes
No
X. FATE OF THE CULTURE AFTER THE PRESCRIBED DURATION OF STORAGE4
The culture can be transferred into the public collection of BCCM/LMG.
The culture can be destroyed by BCCM/LMG.
XI. PATENT AGENT
Should BCCM/LMG send your patent agent a copy of the official receipt (BP/4) and viability statement
(BP/9)?
Yes
No
If yes, give name and address of the patent agent:
Name:
Address:
Phone:
Fax:
E-mail:
3
Additional information might be the isolation source of the micro-organism, the country of origin, the name(s) and address(es) of any
other depositary institution(s) with which the micro-organism has been deposited, or the criterion used when drafting the proposed
taxonomic designation. The supplying of such information is optional.
4
The culture is to be stored for a period of at least five years after the most recent request for the furnishing of a sample of the
deposited organism and, in any case, for at least 30 years after the date of deposit (Rule 9.1. of the Budapest Treaty).
STATEMENT IN THE CASE OF AN ORIGINAL DEPOSIT
PURSUANT TO RULE 6.1.
BCCM/LMG/BP/1
F415C
14/01/2014
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XII. SENDING OF DOCUMENTS
If documents should not be sent to the depositor’s address given in section XIII, then indicate name and
address of the person to whom documents related to this deposit should be sent:
Name:
Address:
Phone:
Fax:
E-mail:
XIII. DEPOSITOR
Name or Institution*:
*In case the depositor is a legal entity, name and function of the authorised representing person should be completed:
Name:
Function:
Address:
Phone:
Fax:
E-mail:
If applicable, please provide the purchase order number:
and the VAT number of your institution:
Date:
Signature:
The depositor shall notify the International Depositary Authority of all changes of address, contact details,
name of authorised representing person, transfer of rights, etc.