PART A – Application			
Details of the Parties
Sender	Receiver	
Organisation’s Name:			Organisation’s Name:			
		
Physical Address:		

	Physical
 Address:			
				
Permit No.
(if applicable):		Country:			Permit No. 
(if applicable):		Country:			
		
Proposed date of shipment:			Proposed date of receipt:			
		
Sender Ref No. for transfer:		
	Receiver Ref No. for transfer:		

Material details
	
Batch number:		Item Identification:		Material category:		

Chemical/physical form, and purity:		

	        For enriched uranium	
Element Weight:		kilograms.….
grams………	235U grams:		233U grams:		

	
Intended use of the material after transfer:		

	
Details about the transfer
	
Containment:		

Name of carrier:		Carrier’s
Permit No:		

Signature(s) of Applicant(s)
Sender [if permit holder]	Receiver [if permit holder]	
Name:  		
	Name:			
				
Position: 		
	Position:			
Signature: 	

____________________________________	Signature:	____________________________________	
Date: 	
____/____/_______	Date:	
____/____/_______	
		
Additional information or attachments:		
	Additional information or attachments:			

ASNO use only	
Approved:	____/____/______

Signature: _____________________________

Approver:  _____________________________	This approval expires on  ____/____/______
Additional conditions:       Yes         No	
Each Applicant must email Part B (page 2) to ASNO by 12 PM on the next working day after the shipment/receipt.

PART B – Confirmation of transfer	Each Applicant must email to ASNO by 12 PM on the next working day after the shipment/receipt.	

Sender [if permit holder]	Receiver [if permit holder]	
Actual date of shipment:	
____/____/______	or	Application Withdrawn…	Actual date of receipt:	
____/____/______	or	Application Withdrawn…	
				
Sender Ref No.		
	Receiver Ref No.			
		
Organisation:		
	Organisation:			
				
Name:		
	Name:			
Signature:	

__________________________________	Signature:	
__________________________________	
Date:	____/____/_______	Date:	____/____/_______	

Explanatory Notes on Approvals
•	For an import or export, approval is only valid if responsibility for the material being imported / exported is transferred on or before the date of expiry of the approval.
•	For a domestic transfer, approval is only valid if the transfer is completed by the date of expiry of the approval.
•	If a transfer is not completed by the date of expiry of the approval, the applicant(s) must lodge a new application and receive ASNO approval thereof before the transfer takes place.
•	For a domestic transfer, the receiver must have a permit issued by ASNO to possess nuclear material.
•	ASNO will email applications for domestic transfers to designated individuals for the other party to confirm the details and obtain signature where required.
•	ASNO may require an end user statement before an export application can be approved. ASNO will email approved export applications to the Department administering Regulation 9 of the Customs (Prohibited Exports) Regulations 1958.

Explanatory Notes on Application Form
Unless otherwise specified by ASNO, please submit this form by email attachment to nuclear.asno@dfat.gov.au. 
This application is only required if a permit holder is aware that nuclear material will be transferred either into (receiver) or out of (sender) their physical possession for more than 30 calendar days, or where ownership of the material changes.

Physical Address……..	Specify the location owned or operated by the organisation where the nuclear material will be sent from or where it will be received.	
Proposed date of shipment/receipt………	
ASNO must be notified in advance of the planned shipment, but in any case, the shipment must not take place before ASNO approval is granted. Note that approvals are typically returned within 7 working days after receipt of application.	
Sender/Receiver Ref No. for transfer…..........	
A sequential reference number is required for each form of this type submitted by each Permit Holder in a calendar year (eg 2020-001, 2020-002, etc). Where amendments are made to a previously submitted form, please use the same reference with a sequential revision number (eg, 2020-003 Rev 1).	
Batch number / Item Identification………......	
Either one or several items with the same chemical and isotopic composition, physical form. Provide individual item identifiers (eg serial numbers) where known.	
Material category……..	Options are D (depleted uranium), N (natural uranium), L (uranium enriched to <20%), H (uranium enriched ≥20%), P (plutonium), T (thorium), W (heavy water), or G (graphite).	
Chemical / physical form and purity………..	
Provide chemical formula (or name if unknown) and describe physical form. Eg UF6 gas, UO2 powder, metal shielding block, Thorium nitrate solution, etc. Common compounds are described for example in the Handbook of Chemistry and Physics and the Merck Index. Describe also purity of batch eg heterogeneous, variable, manufactured, standard etc.	
Element weight………..	This refers to the contained weight of nuclear material in the compound. 
Eg U weight = 84.8% U3O8 weight.  Use compound weight for heavy water.  Use ‘kilograms’ for natural / depleted uranium, thorium and heavy water, and use ‘grams’ for enriched uranium and plutonium.	
Intended use of the material after transfer..	
For example, “Storage”, “Research”, “Industrial Radiography”, “Environmental Tracer”, or “Production of medical isotopes”.	
Containment…………...	Describe type and size/volume of container. Eg. 100g bottle, 0.5 litre flask, within radiography camera.	
Carrier’s permit number………………….	
Some amounts of nuclear material require that a 3rd party carrier obtain a permit to transport nuclear material. A carrier’s permit is not required for material prescribed by the Nuclear Non-Proliferation (Safeguards) Regulations for the purpose of sub-section 24(1) of the Nuclear Non‑Proliferation (Safeguards) Act 1987.	
Signature(s) of Applicant(s)…………….	
This form must only be signed by an individual authorised by the Permit Holder(s) to provide this application, notification or report.	
Part B – Confirmation of transfer………………

After the shipment has taken place, the sender must enter the ‘Actual date of shipment’ and email to ASNO by 12 pm on the next working day after the material is sent.  Similarly, after the receipt has taken place, the receiver must enter the ‘Actual date of receipt’ and email to ASNO by 12 pm on the next working day after the material is received.  If the transfer was cancelled, check the box “Application Withdrawn” and email to ASNO.