National Institute for Biological Standards and Control
PROGRAMME EVA CENTRE FOR AIDS REAGENTS
REAGENT SUBMISSION FORM
DONOR DETAILS:
Name: ...........................................................
Title: ...........................................................
Institution: ...........................................................
Full Address: ...........................................................
Telephone (Area Code): ...........................................................
Fax Number (Area Code): ...........................................................
Email address: ...........................................................
Please state if member of consortia, international project
or collaborative network? If so, please provide details: ...................................................
UserRef: RETCFARFORM24
Version: 1.00
Document Serial No: 5387 from Database: NIBSC
Controlled by WorkBench Professional
Page 1 of 3
Issue Status: ISSUED
Issue Date: 29/09/2009
National Institute for Biological Standards and Control
REAGENT DETAILS:
Name of Reagent: ...........................................................
Brief Description: ...........................................................
Quantity Provided: ...........................................................
Aliquot size: ...........................................................
Concentration (if available):
References, publications if any: ...........................................................
Recommended Applications: ...........................................................
Protocols available for Reagent and Testing: ...........................................................
Examples of Quality Control Testing, if performed: ...........................................................
Repeat request for Reagent possible in the future: ...........................YES...
NO...
TERMS AND CONDITIONS:
Intellectual Property and Publications:
To promote research and development within the HIV/AIDS global scientific community,
reagent donors are encouraged to donate reagents for general distribution with limited or no
restrictions.
Protection of intellectual property can be maintained by restricting reagents for research
purposes and for non-commercial use. The reagent donation form is designed and can be
customised to suit the needs of the reagent donor. Commercial companies requesting a
reagent with restrictions for non-commercial use should contact the reagent donor directly for
permission to obtain it from CFAR. For further terms and conditions placed on the Reagent
UserRef: RETCFARFORM24
Version: 1.00
Document Serial No: 5387 from Database: NIBSC
Controlled by WorkBench Professional
Page 2 of 3
Issue Status: ISSUED
Issue Date: 29/09/2009
National Institute for Biological Standards and Control
Recipient, please refer to the Reagent Release Agreement on our website:
http://www.nibsc.ac.uk/spotlight/aidsreagent/index.html
Please select any of the following (more than one field may apply):

Reagent may be used for commercial purposes
with agreement of donor: .................................................................YES...
NO...

Reagent is available for research purposes only: ...........................YES...
NO...

Reagent is restricted to consortium members only: .......................YES...
NO...

Reagent is available for general distribution: .................................YES...
NO...
ACKNOWLEDGEMENTS:
The repository requires the Recipients of all researchers using donated reagents to
acknowledge both the original donor of the reagents and the Centre for AIDS Reagents in any
associated publications or presentations. Copies of such publications must be sent to the
Centre for AIDS reagents.
Template for example:
“The reagent(s) [Repository number and name of reagent] was obtained from the
Programme EVA Centre for AIDS Reagents, NIBSC, UK, supported by the EC FP6/7
Europrise Network of Excellence, AVIP and NGIN consortia and the Bill and Melinda Gates
GHRC-CAVD Project and was donated by [name of donor, name of donor’s institute]”.
Please provide details of additional members/institutions
to be included in the Acknowledgement Section: ...........................................................
Other information: ...........................................................
Please return completed form to:
Division of Retrovirology, Centre for AIDS Reagents
National Institute of Biological Standards and Control, Blanche Lane, South Mimms, Potters
Bar, Herts, UK, EN6 3QG
Tel: (+44) 1707 641000; Fax: (+44) 1707 641060
Email: CFAR@nibsc.hpa.org.uk
UserRef: RETCFARFORM24
Version: 1.00
Document Serial No: 5387 from Database: NIBSC
Controlled by WorkBench Professional
Page 3 of 3
Issue Status: ISSUED
Issue Date: 29/09/2009