Name of Depositor/Company/Institute
(NB this will be the name that appears on certification)

Contact Name

Tel No

Fax No

Email Address

BIOHAZARD RISK ASSESSMENT MUST BE ENCLOSED

The deposit is made in accordance with the terms of the Budapest Treaty 1977. I agree to abide by the conditions and regulations regarding the deposit of cell lines to ECACC.

Name

Date

Invoice Address

Address Line 1

Address Line 2

Address Line 3

Address Line 4

Town

County

Post Code

Country

PLASMID INFORMATION

Name of plasmid

Suggested host(s)

Molecular weight of Vector

Molecular weight of Insert

Restriction enzyme cloning site

Selection Marker

Cloned DNA Sequence

Is the cloned sequence expressed?

Does the cloned sequence code for toxic or potentially infectious products?

If YES please enclose details

References (please enclose a copy)

HOST INFORMATION

Scientific name of host

Strain Designation

 Culture requirements
(enclose ref if appropriate)

GMO Category

Accessioning of deposits cannot start until this information is available. ECACC can perform this risk assessment but it will take three months to complete. A charge will be levied for this.  A Biohazard Risk Assesment must be completed in order for your samples to be accepted.  ECACC is required to asess the GMO status of all deposits PRIOR to receipt.  Therefore, we will contact all depositors to advise them when we can receive samples