St Vincent’s Hospital (Melbourne)
ANIMAL ETHICS COMMITTEE (AEC)
APPLICATION TO TRANSFER AN ESTABLISHED
STRAIN FROM ANOTHER INSTITUTION (SABC)
NOTES:
1. Please ensure this form is completed using lay language
2. Please complete all relevant sections, incomplete forms will be returned to the researcher
3. Use AEC approved Standard Operating Procedures (SOPs) where possible. Relevant SOPs include:
SOP.8 Murine Health Monitoring Policy
SOP.6 Generation of transgenic mice
SOP.10 Collection of tissues for DNA analysis
Part A - Applicant Details
1. Principal Researcher
Title and Name:
Department:
Institution:
Mailing address:
Qualifications:
Summary of relevant
experience:
Phone:
Fax:
Mobile/pager:
Email:
2. Associate Researcher
Title and Name:
Department:
Institution:
Mailing address:
Phone:
Fax:
Mobile/pager:
E-mail:
3. Animal Technicians
Animal Tech 1
Name:
Department:
Location:
Animal Tech 2
Name:
Department:
Location:
4. Please state the breeding room in which the line will be bred / housed
SABC - Application to transfer an established line
Version 1, January 2012
Part B – Strain Details
1. Please state the name of the new strain (e.g. H-2Kb/hTFPI)
2. Please state the full Mutation Name (Use correct nomenclature)
*For assistance, please see www.jax.org, Transgenic Res 6(5): 309-19 1997, or Genomics 45(2): 471-6 (1997) (e.g. B6TgN(HUTFPI-MUSMH2KB)XXXdAp)
3. Please comment on the stability of the population and why this line is now
thought to be established (include any adverse effects thought to be caused by
the genetic manipulation and the number of generations this line has been
bred for).
4. Please describe any special husbandry or animal care requirements
5. Please provide the Institutional Biosafety Committee (IBC) reference
number
IBC Reference Number:
6. Please state the St Vincent’s Hospital Animal Ethics Reference Number for
the approved project within which this new proposed line will be used
AEC Reference Number:
7. Please describe the fate of the animals that do not have the appropriate
genotype
8. If tissue is to be collected for genotyping, please state how tissues will be
collected for screening:
Biopsy
Tail
Blood
Heparin Blood
Other: _________________
9. Please describe the locus of the modified gene/s for genotyping purposes
(include all mutations as loci 1, loci 2, loci 3 etc)
Locus Number
Mutation Type
Gene Name
Chromosome
10. Please state the background strain (e.g. C57Bl/6):
SABC - Application to transfer an established line
Version 1, January 2012
Part C - Declaration
1. Declaration by Facility Manager:
I hereby confirm we can facilitate the above application to Generate and Breed a
New Mouse Line and adequate housing is available for the proposed number of
animals.
Name:
Position:
Signature:
Date:
2. Declaration by Principal Investigator:
As the Principal Investigator, I hereby confirm that the information provided in this
form is true and correct and that all work will be carried out and managed as per the
Australian Code of Practice for the Care and Use of Animals for Scientific Purposes
(2004).
Name:
Position:
Signature:
Date:
Please note that the approximate number of animals bred must be reported to the
Bureau of Animal Welfare on an annual basis. Therefore, please ensure you keep
accurate records of animal numbers.
SABC - Application to transfer an established line
Version 1, January 2012