SIX1H SCHEDULE Regulations 12 (1), 12(2), 14 (2), 19 Regulation 19 FIFTH SCHEDULE FEES TIlE NATIONAL ENVIRONMENT (ACCESS TO GENETIC RESOURCES AND BENEFIT SHARING) REGULATIONS, 2005 THE UGANDA NATIONAL COUNCIL FOR SCIENCE AND TECHNOLOGY (UNCST) FORM: AGR4 1. 2. Prior informed consent [Reguljltion 12 (2)] 3. Materials Transfer Agreement [Regulation 14(2)] 4. Access permit [Regulation 19] ACCESS PERMIT Permission is hereby granted to MIS ................................... . ................................................................................. ................................................................................. (Name and deSCription of applicant) Application for prior informed consent [Regulation 12 (1)] Shs 50,000/= U4:l."; Shs 120,000/= u< Shs. 300,000/= ~ ................................................................................. (Describe the genetic resources, derivative products or intangible components as stated in the materials transfer agreement) COL. KAHINDA OTAFlIRE Minister of Water, lAnds and Environment. ................................................................................. (State location by local council, village, sub county and district) This permit is issued subject to all the accessory agreements and material transfer agreement concluded pursuant to the Regulations and may be withdrawn should the holder breach any of 'the conditions contained in those agreements and the Regulations. Signed Executive Secretary Competent Authority 409 • Delete whichever is inapplicable 408 "0 Negotiable on a case-by-case basis to access, collect and export the following genetic resources ........ . located at .................................................................... . 'f IJ S ~ 15