ANNEX 1: APPLICATION FOR PRIOR INFORMED CONSENT
Regulation 12(1)
FIRST SCHEDULE
THE NATIONAL ENVIRONMENT (ACCESS TO GENETIC RESOURCES AND BENEFIT
SHARING) REGULATIONS, 2005
APPLICATION FOR PRIOR INFORMED CONSENT
Form: AGR 1
To*:
……………………………………………………………………………..
(lead agency)
……………………………………………………………………………..
(Local Community)
……………………………………………………………………………..
(Owner)
I
/
we*
……………………………………………………………………………………………………………
………………………
of
………………………………………………………………………………………………..…………
……………………….
(address)
hereby apply for prior informed consent to enable me/us to apply to the competent authority to access genetic
resources under your ownership / jurisdiction.
The prior informed consent is being applied for, for the genetic resources located at
………………………………………………………………………………………………
(State location by local council, village, parish, sub-county and district)
The prior informed consent is being applied for in respect of the following genetic resources:
………………………………………………………………………………………………………………………
…………………………
………………………………………………………………………………………………………………………
…………………………
I / we* declare that I am / we* are willing to enter into an accessory agreement with you on terms and conditions
acceptable to you.
I / we* hereby further declare that to the best of my / our information the information given in this application is
correct and true and that the prior informed consent will only be used for applying to the competent authority to
access genetic resources from Uganda
Date: ……………………….
Signature of applicant:
………………………………………………………………
FOR OFFICIAL USE ONLY
Application received on: …………………………………………………………….
Guidelines for Access to Genetic Resources and Benefit Sharing
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