ANNEX 1: APPLICATION FOR PRIOR INFORMED CONSENT Regulation 12(1) FIRST SCHEDULE THE NATIONAL ENVIRONMENT (ACCESS TO GENETIC RESOURCES AND BENEFIT SHARING) REGULATIONS, 2005 APPLICATION FOR PRIOR INFORMED CONSENT Form: AGR 1 To*: …………………………………………………………………………….. (lead agency) …………………………………………………………………………….. (Local Community) …………………………………………………………………………….. (Owner) I / we* …………………………………………………………………………………………………………… ……………………… of ………………………………………………………………………………………………..………… ………………………. (address) hereby apply for prior informed consent to enable me/us to apply to the competent authority to access genetic resources under your ownership / jurisdiction. The prior informed consent is being applied for, for the genetic resources located at ……………………………………………………………………………………………… (State location by local council, village, parish, sub-county and district) The prior informed consent is being applied for in respect of the following genetic resources: ……………………………………………………………………………………………………………………… ………………………… ……………………………………………………………………………………………………………………… ………………………… I / we* declare that I am / we* are willing to enter into an accessory agreement with you on terms and conditions acceptable to you. I / we* hereby further declare that to the best of my / our information the information given in this application is correct and true and that the prior informed consent will only be used for applying to the competent authority to access genetic resources from Uganda Date: ………………………. Signature of applicant: ……………………………………………………………… FOR OFFICIAL USE ONLY Application received on: ……………………………………………………………. Guidelines for Access to Genetic Resources and Benefit Sharing  30