STATEMENT IN THE CASE OF AN ORIGINAL DEPOSIT
PURSUANT TO RULE 6.1.
BCCM/MUCL/BP/1
F415D
17/12/2013
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)
Université catholique de Louvain
Mycothèque de l’Université catholique de Louvain (MUCL)
Croix du Sud 2, box L7.05.06
1348 Louvain-la-Neuve
Belgium
Form
BCCM/MUCL/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:
Sensitivities, resistances, auxotrophies of mutants:
Other requirements:
III. CONDITIONS FOR STORAGE
MARK WITH A CROSS IF ADDITIONAL INFORMATION IS GIVEN ON
AN ATTACHED SHEET
Applicable preservation methods:
Continuous culture
Lyophilisation
Culture under mineral oil
Cryopreservation
Culture under water
The 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/MUCL/BP/1
IV. CONDITIONS FOR TESTING VIABILITY
V. COMPONENTS OF THE MIXTURE (IF APPLICABLE)
F415D
17/12/2013
Page 2 of 4
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/MUCL/BP/1
VIII. ADDITIONAL DATA3
F415D
17/12/2013
Page 3 of 4
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/MUCL.
The culture can be destroyed by BCCM/MUCL.
XI. PATENT AGENT
Should BCCM/MUCL 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/MUCL/BP/1
F415D
17/12/2013
Page 4 of 4
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 authorized 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 authorized representing person, transfer of rights, etc.