Part A Information to be transmitted to the ABS Clearing House pursuant to Article 7(3) of Regulation (EU) No 511/2014

If the information provided is confidential within the meaning of Article 7(5) of Regulation (EU) No 511/2014, please provide it nonetheless, tick the respective box and provide the justification for confidentiality at the end of this Annex.

If you marked as confidential essential information (such as about the genetic resources or traditional knowledge associated with genetic resources, access place, form of utilisation) without which the record would not be published on the website of the ABS Clearing House, this information will not be shared with the Clearing House but it may be passed on directly to the competent authorities of the provider country.

If the utilisation has involved more than one genetic resource or any traditional knowledge associated with genetic resources, please provide relevant information for each genetic resource or any traditional knowledge utilised.

I declare that I have fulfilled the obligations under Article 4 of Regulation (EU) No 511/2014. I am making this declaration for the utilisation of:

Please tick the appropriate box or boxes:

• ☐ Genetic resources

• ☐ Traditional knowledge associated with genetic resources

1. 1..

   Name of the product or description of the result of the utilisation^f1 or description of the outcome of the utilisationM1:

   ☐ Confidential

2. 2..

   Contact details of the user:

   • Name:

   • Address:

   • E-mail:

   • Telephone:

   • Website, where available:

3. 3..

   The declaration is made on the occasion of the following event:

   Please tick the appropriate box:

   1. ☐ (a)

      market approval or authorisation is sought for a product developed via the utilisation of genetic resources and traditional knowledge associated with genetic resources;

   2. ☐ (b)

      a notification required prior to placing for the first time on the F1United Kingdom market is made for a product developed via the utilisation of genetic resources and traditional knowledge associated with genetic resources;

   3. ☐ (c)

      placing for the first time on the United Kingdom market a product developed via the utilisation of genetic resources and traditional knowledge associated with genetic resources, for which no market approval, authorisation or notification is required;

   4. ☐ (d)

      the result of the utilisation is sold or transferred in any other way to a natural or legal person within the United Kingdom in order for that person to carry out one of the activities referred to in points (a), (b) and (c);

   5. ☐ (e)

      the utilisation has ended in the United Kingdom and its outcome is sold or transferred in any other way to a natural or legal person outside the United Kingdom.

4. 4..

   Information on exercise of due diligence:

   1. (a)

      ☐ An internationally recognised certificate of compliance (i) was issued for my (entity's) access or (ii) covers the terms of this access to the genetic resource(s) and traditional knowledge associated with genetic resources.

      Where this box is ticked, please indicate the unique identifier of the internationally recognised certificate of compliance:

      Please go to point 2 of Part B.

   2. (b)

      Where the box in point (a) has not been ticked, please fill in the following information:

      1. (i)

         Place of access:

         ☐ Confidential

      2. (ii)

         Description of the genetic resource or traditional knowledge associated with genetic resources utilised, or unique identifier(s), where available:

         ☐ Confidential

      3. (iii)

         Date of access:

         ☐ Confidential

      4. (iv)

         Identifier of access permit or its equivalent^f2, where available:

         ☐ Confidential

      5. (v)

         Person or entity who granted prior informed consent:

         ☐ Confidential

      6. (vi)

         Person or entity to whom the prior informed consent was granted:

         ☐ Confidential

      7. (vii)

         Is the utilisation of genetic resources and traditional knowledge associated with genetic resources subject to mutually agreed terms?

         Yes ☐

         No ☐

         ☐ Confidential

         Please go to point 1 of Part B.