GMO Transfer Request Template

Applicant Information

Name Department Contact Email Phone

Recipient Information

Recipient Name Recipient Institution Recipient Address Recipient Country

GMO Details

Organism Description Modification Type Purpose of Transfer Quantity

Containment & Handling

Containment Level Special Handling Procedures

Shipping Information

Shipping Method Estimated Shipping Date Tracking Information

Approvals

Approval	Name	Date	Signature
Biosafety Officer
Responsible Researcher
Institutional Authority