Application form for access to Biological resources and associated traditional knowledge  
      Download Application Form I [ Hindi]     Download Application Form A [ Hindi]     Download Declaration Under section 3(2) [ Hindi]  
      Download Application Form I [ English]     Download Application Form A [ English]     Download Declaration Under section 3(2) [ English]  
 
1. Full particulars of the applicant
Name : *
Email : *  
Permanent address : *
Address of the contact person/agent, if any, in India :
Profile of the organization (personal profile in case the applicant is an individual). Please attach relevant documents of authentication) :
Nature of business : *
Turnover of the organization :
 
2. Details and specific information about nature of access sought and biological material and associated knowledge to be accessed
Identification of biological resource(s)

Common NameScientific NameTraditional Use of the Bio-resources#


Geographical location of proposed collection collection (includes District,Nagar Nigam , Nagar Palika, Nagar Panchayat, janpad Panchayat and Gram Panchayat)

DistrictNagar Nigam Nagar PalikaNagar PanchayatJanpad Panchayat Gram PanchayatDelete


Description/nature of traditional knowledge (oral/documented) :
Any identified individual/community holding the traditional knowledge :
Quantity of biological resources proposed to be collected (give the schedule): (Months of collection) :
Time span in which the biological resources is proposed to be collected: (Complete duration of extraction of bio-resources)
Name and number of person authorized by the company for making the collection :
The purpose for which the access is requested including the type and extent of research, commercial use being derived and expected to be derived from it :
Whether any collection of the resource endangers any component of biological diversity and the risks which may arise from the access :
   
Other Details
Estimation of benefits, that would flow to communities arising out of the use of accessed bio-resources and traditional knowledge :
Proposed mechanism and arrangements for benefit sharing :
Any other information considered relevant :
Demand Draft Information

DD should be Payable in favour of Member Secretary MP State Biodiversity Board, Bhopal.
* Application fee is not refundable.
* Application shall be considered only if the required fee is paid.
* Application fee should be in the form of cheque or Demand draft only.
* Application fee if access to bio resource is for commercial purpose: 1000 ,
* Application fee if access to bio resource is for research purpose: 100 ,
DD/Cheque Number : *
DD/Cheque Date : *
Bank Name : *
Branch Name : *
Declaration
I/we declare that
  • Collection of proposed biological resource(s) shall not adversely affect the sustainability of the resource(s)
  • Collection of proposed biological resource(s) shall not entail any environmental impact
  • Collection of proposed biological resource(s) shall not pose any risk to ecosystems
  • Collection of proposed biological resource(s) shall not adversely affect the local communities
I/we further declare the information provided in the application form is true and correct and I/we shall be responsible for any incorrect/wrong information
 
     
     
   
     
 
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