ANNEX 5: ACCESS PERMIT Regulation 19 THE NATIONAL ENVIRONMENT (ACCESS TO GENETIC RESOURCES AND BENEFIT SHARING) REGULATIONS, 2005 THE UGANDA NATIONAL COUNCIL FOR SCIENCE AND TECHNOLOGY Form: AGR 4 ACCESS PERMIT Not Transferable Permission is hereby granted ……………………………………………………………………………………………. to M/S ……………………………………………………….……………………………………………………………… ………………………… ……….……………………………………………………………………………………………………………… ………………………… (Name and description of applicant) to access, collect and export …………………………………………………………. the following genetic resources ………………………….…………………………………………………………………………………………… …….………………….. ……………………………………………………………………………….……………………………………… ………………………… (Describe the genetic resources, derivative products or intangible components as stated in the materials transfer agreement) located at ……………………………………………………………………………………………………………………… ………….. ………………………………….…………………………………………………………………………………… ………………………… …………………………………..………………………………………………………………………………… ………………………….. (State location by local council, village, sub-county and district) This permit is issued subject to all the necessary agreements and material transfer agreement concluded pursuant to the Regulations and shall be withdrawn should the holder breach any of the conditions contained in those agreements and the Regulations. Signed: ………………………………………………………… Guidelines for Access to Genetic Resources and Benefit Sharing  ……………………………………….. 40