National Environmental Management: Biodiversity Act, 2004 (Act No. 10 of 2004)RegulationsBio-prospecting, Access and Benefit-Sharing Regulations, 2008AnnexuresAnnexure 3 : Application for an export permit for the purposes of conducting research other than bioprospecting |
Notes on completing form: |
If insufficient space is provided in this form, additional information may be included by way of annexures. |
APPLICANT
If applicant is a juristic person complete clauses 1- 7 below
| 1. | Full name of institution or body: |
| 2. | Is the juristic body registered in South Africa? Y/N |
| 3. | If yes, provide the South African registration number of the juristic body: |
| 4. | If not, which country is the juristic body registered in and provide the reference number: |
| 5. | Provide the contact details of the juristic body (including postal/physical address, phone, fax and e-mail address): |
| 6. | Name of contact person in juristic body (attach a certified copy of ID document): |
| 7. | Capacity of contact person: |
If applicant is a natural person complete clauses 8 - 12 below
| 8. | Name of applicant: |
| 9. | Identity number of the applicant (also attach certified copy of the ID): |
| 10. | Contact details of applicant (including postal/physical address, phone, fax and e-mail address): |
| 11. | ls the applicant affiliated to any juristic body? Y/N |
| 12. | If yes, provide the name and contact details of the juristic body (include name of contact person, postal/physical address, phone, fax and e-mail address): |
The rest of this part to be completed by all applicants
13. Names and contact details (includes postal/physical address, phone, fax and e-mail address) of all other collaborators:
| 14. | Identity number of all other collaborators (also attach certified copy of the ID): |
| 15. | Names and contact details (includes postal/physical address, phone, fax and e-mail address) of the individuals who will conduct research: |
| 16. | Identity number of the individuals who will conduct research (also attached certified copies of IDs): |
| 17. | Are there any international sponsors funding this project? Y/N |
| 18. | If yes, provide their names of sponsors and contact details(includes name of contact person, postal/physical address, phone, fax and e-mail address): |
| 19. | Are there any South African sponsors funding this project? Y N |
| 20. | If yes, provide their names of sponsors and contact details(includes name of contact person, postal/physical address, phone, fax and e-mail address): |
RECIPIENT OF INDIGENOUS BIOLOGICAL RESOURCES BEING EXPORTED (IMPORTER)
21. Name of recipient/importer:
| 22. | Contact details of recipient/importer (include postal/physical address, phone, fax and e-mail address): |
INDIGENOUS BIOLOGICAL RESOURCES
| 23. | Set out the type of indigenous biological resources for which a permit is sought, the family, genus and species, the part of the organism to be collected, the quantity of the resources to be collected or obtained and the specific area or source from which each resource is to be collected or obtained. |
Type of organism |
Family, genus or species (scientific and common names) (if possible) |
Part of organism to be collected |
Quantity |
Full locality data (GIS readings if possible) |
Example:
Plant |
Aloe ferox |
Leaves |
6kg |
.... |
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PREVIOUS PERMITS
| 24. | In respect of the indigenous biological resources set out above, has any other application for a permit in terms of the Act or in terms of any other legislation been submitted, either previously or simultaneously with this application? Y/N |
25. If yes, was the application granted, refused or is it still pending?
| 26. | If the application was granted, provide the following detail and attach a copy of the permit. |
Permit number |
Issuing authority |
Date of issue |
If the application is still pending, provide the issuing authority's reference number:
REQUIREMENTS OF OTHER LEGISLATION
| 27. | Have you complied, or have you taken steps to comply, with other legislative requirements for the collection and export of the indigenous biological resources? Provide details, including reference numbers and waybill numbers where appropriate. |
PROJECT PROPOSAL
| 28. | A detailed project proposal must be attached to this application setting out the following— |
| 28.1 | the objectives of the research; |
| 28.2 | the benefits that may result from the project; |
| 28.3 | the proposed methodology; |
| 28.4 | the proposed time-frames(i.e. required period of validity of permit); |
| 28.5 | any relevant environmental considerations including impacts of the collection of the resources and proposed steps to minimise or remedy those impacts; |
| 28.6 | reporting processes; |
| 28.7 | desired outcomes of the project; and |
| 28.8 | what will happen to the discarded/ wasted specimens at the end of the study. |
PURPOSE OF EXPORT
29. State the purpose for which the indigenous biological resources are to be exported:
| 30. | Will the intended research that is the subject of the permit application, have some benefit for |
30.1 the conservation of biodiversity in South Africa Y/N
30.2 the economic development of South Africa Y/N
30.3 any other matter that is in the public interest? Y/N
31. If yes, provide details:
FEES
| 32. | Has the fee of R200 been paid? Please attach a copy of the invoice. Y/N |
Signature of applicant for permit:
| Date: |
Capacity of signatory:
Endorsement of juristic body, if applicable
Name of juristic body:
Signature of duly authorised officer from the juristic body:
| Date: |