BELGIAN COORDINATED COLLECTIONS OF MICROORGANISMS
BCCM/IHEM-COLLECTION
Form BCCM/IHEM/BP/11/................ Request for the furnishing
of samples of deposited microorganisms pursuant to Rule 11.2 (ii)
(Fill out in duplicate)
| Budapest Treaty of 28 April 1977 on the
International Recognition of the Deposit of
Microorganisms for the Purposes of Patent Procedure. Request
for the furnishing of samples of deposited microorganisms
pursuant to Rule 11.2 (ii)
Form BCCM/IHEM/BP/11/................ to be
completed in duplicate (number to be filled in by
IDA)
(General remark: Always mark the
applicable  (or
boxes) with a cross)
|
- Send to:
- Belgian Coordinated Collections of Microorganisms
(BCCM)
Institut Scientifique de la Santé Publique - Louis
Pasteur (IHEM)
- Section mycologie
J. Wytsmanstraat 14 Rue J. Wytsman
- B-1050 Brussels, Belgium
The undersigned authorized party hereby requests the
furnishing of a sample of the microorganism identified hereunder,
in accordance with Rule 11.2 (ii) of the Regulations under the
Budapest Treaty
I. Identification of the microorganism:
- Accession number of the deposit:
-
-
II. Declaration of the depositor
- The undersigned depositor of the microorganism
identified under I above hereby authorizes the furnishing
of a sample of the said microorganism to the party
specified under IV below.
-
- Name:
-
- Address:
-
- Signature:
-
- (Where the signature is required on behalf of a legal
entity, the typewritten name(s) of the natural person(s)
signing on behalf of the legal entity should accompany
the signature(s)).
-
- Date:
-
III. Request for information
- The undesigned authorized party
-
- requests
does not request
- an indication of the conditions which the international
depositary authority employs for the cultivation and
storage of the microorganism.
IV. Authorized party
- Name:
-
- Address:
-
- Signature:
-
- (Where the signature is required on behalf of a legal
entity, the typewritten name(s) of the natural person(s)
signing on behalf of the legal entity should accompany
the signature(s)).
-
- Date:
-