This form should only be used for licensed (DNIR) dealings that may be NLRDs (after 1 September 2011)

RTF Form

Request to surrender DNIR licence where dealings have been assessed as an NLRD (update of the previous form 'Combined NLRD Notification & Surrender of DNIR licence) (RTF 243 KB)


Text Version

Below is the text from the Request to surrender DNIR licence where dealings have been assessed as an NLRD

Part 1: Assessment of an NLRD under Regulation 13 of the Gene Technology Regulations 2001

Name of IBC

I declare that:
  • The IBC has assessed the dealings described in Table 1 (attached) to be notifiable low risk dealings (NLRD) mentioned in Part 1 or Part 2 of Schedule 3 of the Gene Technology Regulations 2001 (as amended, commencing 1 September 2011);
  • Personnel involved in these dealings have appropriate training and experience;
  • The dealings are undertaken in facilities that are appropriate for the dealings; and
  • Dealings involving transport, storage or disposal of a GMO are undertaken in accordance with the Regulators Guidelines for the Transport, Storage and Disposal of GMOs.
IBC rep name
Signature
IBC rep title
Date

Part 2: Request to surrender a licence for a dealing not involving an intentional release (DNIR)

Name of Organisation holding DNIR licence holder

  • I declare that I am authorised (as CEO or Delegate of the above organisation) to sign on behalf of the licence holder; and
  • I hereby request that the respective DNIR licence(s) be surrendered.
Delegate/CEO name
Signature
Delegate/CEO title
Date

Table 1 List of dealings relating to Parts 1 & 2 of this form

Title
Current DNIR Number
Project Supervisor
NLRD Type*
IBC NLRD Identifier1

* Refer to Schedule 3, Part 1 and Part 2 of the Gene Technology Regulations 2001 (commencing 1 September 2011) for information on appropriate classifications
1 Please include your organisations identification number/label issued by your IBC. This reference/number should also be included in your list of new NLRDs notified to the OGTR in your organisations annual report (due after 1 July of each year).