Department of Environmental Protection and Conservation Private Mail Bag 9063 Port Vila, Vanuatu Phone: (678) 25302 / 33430 VOIP: 2640 Email: dkalfatak@vanuatu.gov.vu
How to complete this application form
This application form and any supporting information provided with it are for a Bioprospecting Permit under the Environmental Protection and Conservation Act [CAP 283]. Bioprospecting is any activity undertaken to harvest or exploit all or any of the following: samples of genetic resources (material of plant, animal, microbial or other origin containing functional units of heredity that is of actual or potential value); samples of any derivatives of genetic resources; the knowledge, innovations, and customary practices of local communities associated with those genetic resources; for purposes of research, product development, conservation or industrial or commercial application, and includes investigative research and sampling, but does not include customary uses of genetic resources and derivatives. Any person wanting to undertake bioprospecting in Vanuatu must apply to the Director of the Department of Environmental Protection and Conservation (the Department) for a Bioprospecting Permit. This includes bioprospecting undertaken by regional universities or other organisations, including where bioprospecting is provided for under a memorandum of understanding. This form is designed to help you fully describe your bioprospecting activities. Your application will not be referred to the Biodiversity Advisory Committee (BAC) unless you return this form, completed and signed; all relevant attachments and required information; and have paid the application fee and bioprospecting information bond. Payment of fees and bonds: Application fees and bioprospecting information bonds must be paid at the government cashier at the Department of Finance and Treasury. We do not accept payments at our offices. Please take the attached invoice to the government cashier for payment. A receipt from the government cashier must be attached to your application when it is submitted. Consultation and contractual arrangements: For your application to be determined, you must have: Consulted with the relevant custom landowners and community; and Entered into a legally binding and enforceable contract with the custom landowners and/or the owners of the traditional knowledge associated with your application. This is referred to as the access and benefit sharing contract (the ABS contract) and reflects the prior informed consent, given by the custom landowners/owners of traditional knowledge, to grant access to the genetic resources/traditional knowledge; and the mutually agreed terms for the sharing of benefits arising from the utilisation of the genetic resources/traditional knowledge. It is not necessary for you to have started or completed these activities before you submit your application. Where these activities have not been started or completed, we will facilitate these processes and the details will be included with your application when it is referred to the BAC for determination. Please note, the timeframe for making a decision does not start until your application is referred to the BAC. Once your application has been received by the BAC, the BAC has 21 business days to meet and determine your application. Following the BAC’s decision, we have a further 14 business days in which to advise you of the BAC’s decision. NO BIOPROSPECTING MAY OCCUR UNLESS AND UNTIL A BIOPROSPECTING PERMIT IS GRANTED BY THE BAC!

THE APPLICANT
Full name of applicant
Business details
University or research institute Registered business (if registered in Vanuatu, attach copy of your business licence) Other organisation (if registered in Vanuatu, attach copy of your VFSC certificate) Organisation name & CT number:
Nationality
Contact details
Physical address:
PO Box:
Tel: Mobile: Email:
Website:
Confidentiality
Yes No If yes, please state what information should be regarded as confidential:

QUALIFICATIONS
Please attach your current curriculum vitae and complete this section for all relevant qualifications. Insufficient or unclear information will delay your application. Please use separate sheet(s) if required.
BACHELORS DEGREE	WHAT IS THE NAME OF YOUR BACHELORS DEGREE?	WHEN DID YOU RECEIVE YOUR BACHELORS DEGREE?	WHAT UNIVERSITY OR OTHER INSTITUTE AWARDED YOUR BACHELOR DEGREE?
OTHER QUALIFICATIONS	Please describe any other relevant qualifications such as certificates (levels I, II, III or IV), diplomas, graduate certificates, graduate diplomas, postgraduate certificates, postgraduate diplomas, Masters degrees or Doctoral degrees.
PROFESSIONAL ASSOCIATIONS	Please provide details of relevant professional organisation/association memberships.

YOUR ASSOCIATES
Please complete this section for all associates, affiliates or parties that may benefit or share in your bioprospecting activities or obtain any benefit from your bioprospecting activities. Please use separate sheet(s) if required. If you have no associates/others will not be involved in your bioprospecting activities, please mention this in this section. Full name
Business details
University or research institute Registered business (if registered in Vanuatu, attach copy of your business licence) Other organisation (if registered in Vanuatu attach copy of your VFSC certificate) Organisation name & CT number:
Nationality
Contact details
Physical address:
PO Box:
Tel: Mobile: Email:
Website:
Full name
Business details
Registered business (if registered in Vanuatu, attach copy of your business licence) Other organisation (if registered in Vanuatu attach copy of your VFSC certificate) Organisation name & CT number:
Nationality
Contact details
Physical address:
PO Box:
Tel: Mobile: Email:
Website:

YOUR BIOPROSPECTING ACTIVITIES
To assess your application we need to understand the nature and extent of your bioprospecting activities and where your bioprospecting activities will occur. When describing your bioprospecting activities, please include as much information as possible and use additional sheets of paper if required. Insufficient or unclear information will delay your application.
WHAT IS THE PURPOSE OF YOUR BIOPROSPECTING?
WHAT BIOLOGICAL RESOURCES WILL BE INVESTIGATED? Please include the taxonomic name and common name of any biota proposed to be investigated.
WHAT TRADITIONAL KNOWLEDGE WILL BE INVESTIGATED?
WHAT BIOPROSPECTING ACTIVITIES WILL BE UNDERTAKEN? Bioprospecting activities may involve a number of stages or phases (e.g., research, product development, conservation, industrial or commercial application etc.). Please use this section to describe, in detail, the nature and extent of your application. You must include or attach: If you will be collecting samples, details of the number of samples/specimens to be taken A research and investigation plan outlining the investigation and sampling methods to be used, the names and contact details of the proposed research team and a list of equipment and materials to be used An outline of the nature, duration and extent of any commercial research and development that may result from your bioprospecting activities.
WHERE WILL BIOPROSPECTING ACTIVITIES TAKE PLACE? Give name of island, area, nearest town or village and other directions. Please include a map clearly showing the location in relation to neighbouring properties, coastal or other features etc.
WHEN WILL BIOPROSPECTING ACTIVITIES BE UNDERTAKEN? Include, for example, the number of visits you propose to make to Vanuatu and the length of time you will be in Vanuatu to undertake your bioprospecting activities.
WHO IS FUNDING YOUR BIOPROSPECTING? If your bioprospecting activities are supported by donor funding, please specify the funding support provided and attach the funding proposal.
WHAT BENEFITS DO YOU ANTICIPATE RECEIVING FROM YOUR BIOPROSPECTING ACTIVITIES?
WHAT BENEFITS YOU ANTICIPATE VANUATU RECEIVING FROM YOUR BIOPROSPECTING ACTIVITIES?

CONSULTATION AND THE ABS CONTACT
Your application will not be approved unless and until you have consulted with the relevant custom owners and community; and you have concluded an ABS contract with the custom landowners and/or any owner of traditional knowledge. If you have started consulting with the custom land owners and community, negotiating an ABS contract, or have entered into an ABS contract, please include the details as part of your application. If you have not started consulting with the custom land owners and community, negotiating an ABS contract or have not entered into an ABS contract, we will facilitate this process and the details will be included with your application when it is submitted to the BAC for determination.
WHAT IS THE STATUS OF THE LAND WHERE YOUR BIOPROSPECTING WILL TAKE PLACE? Please tick the relevant box and provide the required details. For leased land, please include a copy of the land lease.	Leased land Title number: Lease class: Customary land Custom owner:
HAVE YOU CONSULTED WITH THE RELEVANT CUSTOM OWNER AND COMMUNITY? Please tick the relevant box and provide the required details.	Yes No If yes, please describe who was consulted and the results of consultation.
HAVE YOU CONSULTED WITH THE RELEVANT MUNICIPAL OR PROVINCIAL GOVERNMENT COUNCIL?	Yes No If yes, please describe who was consulted and the results of consultation.
HAVE YOU ENTERED INTO/STARTED NEGOTIATIONS FOR AN ABS CONTRACT WITH THE CUSTOM LAND OWNER AND/OR OWNER OF TRADITIONAL KNOWLEDGE? Please tick the relevant box and provide the required details.	Yes No If yes, please attach copies of any relevant ABS contracts/draft ABS contracts/template ABS contracts. Note: The details of ABS contracts/draft ABS contracts will be treated as confidential information.

CHECKLIST
This checklist lists all of the information that must be included as part of your application. If you do not complete this application form and provide the necessary information we will ask you to provide more information.
All applicants: Please tick to confirm each item on this checklist	Official use only
Completed all sections of this application form Attached copies of/included: Number of specimens to be taken Research and investigation plan Outline of the nature, duration and extent of any commercial research and development that may result from the bioprospecting Location map showing location of bioprospecting activities Evidence of payment of the 50,000 vatu application fee (e.g., receipt from the Department of Finance and Treasury) Evidence of payment of the 100,000 vatu bioprospecting information bond (e.g., receipt from the Department of Finance and Treasury)	Completed all sections of this application form Attached copies of/included: Number of specimens to be taken Research and investigation plan Outline of the nature, duration and extent of any commercial research and development that may result from the bioprospecting Location map showing location of bioprospecting activities Evidence of payment of the application fee (50,000 vatu) Evidence of payment of the bioprospecting information bond (100,000 vatu)

DECLARATION
If you are the applicant: By signing this application, I/We : Declare I am/we are the person responsible for the bioprospecting the subject of this application. Declare all the information presented herein and attached is true and correct. Undertake to provide the Director of the Department with any preliminary information gathered during the bioprospecting within four weeks after the bioprospecting is undertaken. Undertake to provide the Director of the Department with a final report within 12 months after the bioprospecting is undertaken. Applicant’s signature: Date: _____________________ (Official Stamp where applicable) If you are an authorised representative of the applicant: By signing this application, I/We declare: I am/We are the authorised representative of ___________________________, the person responsible for the bioprospecting the subject of this application. All the information presented herein and attached is true and correct. Undertake to provide the Director of the Department with any preliminary information gathered during the bioprospecting within four weeks after the bioprospecting is undertaken. Undertake to provide the Director of the Department with a final report within12 months after the bioprospecting is undertaken. Representative’s signature: Date: _____________________ (Official Stamp where applicable)

ANY BIOPROSPECTING PERMIT GRANTED WILL BE PRIMARILY BASED ON THE DESCRIPTION YOU HAVE PROVIDED ON THIS FORM. ANY CHANGES OR VARIATIONS TO YOUR BIOPROSPECTING ACTIVITIES MUST BE REFERRED TO THE DEPARTMENT BEFORE BIOPROSPECTING ACTIVITIES ARE UNDERTAKEN.

THIS APPLICATION IS FOR A BIOPROSPECTING PERMIT UNDER THE ENVIRONMENTAL PROTECTION AND CONSERVATION ACT ONLY.

THE GRANTING OF A PERMIT UNDER THE ENVIRONMENTAL PROTECTION AND CONSERVATION ACT DOES NOT INFER OR ASSUME THE GRANTING OF LICENCES OR PERMITS UNDER ANY OTHER VANUATU LEGISLATION.