PROGRAMME EVA CENTRE FOR AIDS REAGENTS

REAGENT RELEASE AGREEMENT

Reagent(s) Requested:

1.Catalogue Number: CFARDescriptionAmount

2.Catalogue Number: CFARDescriptionAmount

3.Catalogue Number: CFARDescriptionAmount

4.Catalogue Number: CFAR DescriptionAmount

Is your research part of a national / international collaborative project, network or consortium? If so please give details*:
Name of project/network/consortium:Source of funding:
*These details will help us in providing statistics, feedback and other information on the service that we provide.

Justification for request (continue on separate sheet if necessary):

Reagents, and know-how associated with their use, are provided on the following conditions:

1.You will not permit the Materials or any part of them to come into the possession or control of any other person except those engaged in research under your supervision who have accepted the same obligations as yourself in respect of the Materials.

2.You will use the Materials for research purposes only and will not use them or permit them to be used in any way for the production or sale of any products for commercial purposes.

3.The Materials (or materials derived from them) WILL NOT be administered to humans.

FOR OFFICE USE ONLY

Charged: / Not Charged:
Handling Charges: / Reason:
Shipping Charges:
Total Charges:
Approved by: / Date: / Invoice No: / Sent by: / Date:
  1. Where results and/or discoveries made by you from the use of the Materials may be of commercial value, you agree to ensure timely notification of the donor of the reagent and to withhold publication or oral presentation of these results for a minimum of 30 working days to allow them the opportunity to assess if all steps have been taken to protect Intellectual Property.

5.Any publications or presentations of your work with the Materials will duly acknowledge the original donor of the Materials, theProgramme EVA Centre for AIDS Reagents using the wording suggested in the paperwork accompanying the reagent.Copies of such publications will be sent to the Resource Manager at the address given below.

6.On conclusion of the research programme using the Materials, you will offer any remaining Materials to the Centre and you will continue to abide by the obligations and restrictions set out in this letter.

7.Any infectious or potentially infectious materials will only be handled in appropriate containment facilities by fully trained and competent staff in accordance with the appropriate national guidelines. (eg Protection against blood-borne infections in the workplace: HIV and hepatitis, Advisory Committee on Dangerous Pathogens, UK, published 1996 by The Stationery Office, London). NIBSC accepts no liability whatsoever for any damage, injury or death resulting from the use of these materials.

8.Although all reasonable steps are taken by NIBSC to ensure that any reagents supplied to researchers are those ordered by the researchers, the NIBSC accepts no liability whatsoever for any damage, injury or death resulting from either the supply of any reagents which is not a reagent requested by the researcher or the supply of any mislabelled or misdescribed reagent.

If the foregoing conditions are acceptable to you, please complete and return this form. Following receipt of the completed form arrangements will be made for the despatch of the Materials to you. You may wish to take a photocopy of this form for your records.

“We certify that we have read and accept the conditions listed above. We agree to undertake payment for the handling and delivery charges set by the Centre for AIDS Reagents.” (For further details see Handling Charges).

ApplicantCounter Signatory(Principal Investigator/Head of Dept or Inst)

Print Name:...... Print Name:......

Signature...... Signature......

Date...... Date:......

Full address to which materials should be sent:
(PLEASE USE BLOCK CAPITALS)
Telephone Number:
Fax Number:
E-mail: / Full address to which invoice should be sent:
(PLEASE USE BLOCK CAPITALS):
Purchase Order Number:
VAT Number:
Is a VAT exemption certificate enclosed: Yes No
Telephone Number:
Fax Number:
E-mail:
Is an import permit required? / Yes / No / If yes, is the permit enclosed? / Yes / No
Please return the completed form to:-
Dr Meghna Ramaswamy, Post Doctoral Project Development Scientist or Sarah Goriup, Project Manager
National Institute for Biological Standards and Control
Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK.
Fax: +44 1707 641060 (for UK use 01707...... )  Tel: +44 1707 641000
email:
(Applications may be faxed or scanned and sent as an attachment by email.)
However the original Reagent Agreement must be sent via post/courier.

IF YOU ARE VAT EXEMPT PLEASE ENSURE THAT YOUR VAT ZERO RATING CERTIFICATE IS ENCLOSED WITH THIS REAGENT RELEASE AGREEMENT OTHERWISE YOU WILL BE CHARGED VAT.

Instructions for ordering reagents from the Centre for AIDS Reagents:

  • Scientist requesting EVA648 recombinant gp120 W61D or ARP3101 Monoclonal antibody to CXCR4 12G5 must complete a special Reagent Release Agreement. This can be provided on request.
  • Scientists requesting WHO-UNAIDS reagents must also complete the current version of the WHO-UNAIDS Reagent Release Agreement. This can be emailed to you on request or found on our website at:
  • Completed forms can be submitted by FAX, but the original signed copies must also be sent via post.
  • Failure to complete all relevant sections of this form may result in the delay of reagents being dispatched.
  • Completed forms must contain
  • Scientific justification for request.
  • Signature of countersignatory (principle investigator or Head of Department).
  • Telephone number, fax number and email address.
  • Copy of Purchase Order or Purchase Order number.
  • If known, VAT exemption number or certificate. (VAT* is relevant to EU customers only)
  • We aim to dispatch all orders within 10 working days of receipt of the complete order, including all relevant paperwork and permits, provided reagents are available for dispatch.
  • Import Permit

Where necessary, a valid importation permit must be included. Contact your local customs authority if you are unsure about import regulations. The sites below may be of some help for importation restrictions and requirements:

The IATA Dangerous Goods Regulations:

Etiological Agent Import Permit Program (USA):

  • Disclaimer

Although materials provided through the repository are presented on good faith, Programme EVA CFAR (EVA CFAR) at the National Institute of Biological Standards and Control (NIBSC) makes no representations or warranties as to the safety, accuracy, usefulness or completeness of information and products disclosed. Materials provided to repository users are for research purposes only and customers must validate these products for their own research use.

UserRef: RET/CFARFORM1Version: 3.00Issue Status: ISSUED

Document Serial No: 4956 from Database: NIBSC

Controlled by WorkBench ProfessionalPage 1 of 3Issue Date: 29/06/2009