Ref. No.		
What is this Application for?	
	
Nuclear Material 	Consumption?		Dilution?		Disposal?			

Associated Item	Disposal?		Proposed date:	
	
NUCLEAR MATERIAL details
	
Batch number:		Item Identification:		Material category:			
	
Chemical/physical form, and purity:			
	
Attributed country obligation?		Irradiated? (Yes/No)		Containment:			
		For  enriched  uranium	
Element Weight:		Kg 	
grams		235U grams		233U grams:			
	
Proposed use of the material:			
	
ASSOCIATED ITEM details
	
Item name:		Item Classification:		Item status:			
	
Country of origin:		Foreign obligation:			
	
Item description:	

Description of the activities     if insufficient space, send attachments
	
Description of how the nuclear material—OR associated item—will be consumed, diluted, or disposed of, as applicable:	

	
Description of how the material will become “practicably irrecoverable”.	

		

Applicant’s Signature	ASNO use only	
	Approved:	____/____/______

__________________________
For Director General ASNO	
Name :				
		
Position:				
Signature:	___________________________	Date:	____/____/________		
	
Name of Permit Holder:		Permit number:			
	
Explanatory Notes
** Approval is not required for the consumption of nuclear material in nuclear reactors **

Ref No		A sequential reference number is required for each form of this type submitted by the Permit Holder (eg 001, 002, 003 etc). Where amendments are made to a previously submitted form, please use the same reference with a sequential revision number (eg 2005-003 Rev 1)	
Nuclear material		As defined in the Nuclear Non-Proliferation (Safeguards) Act 1987	
Associated item		As defined in the Nuclear Non-Proliferation (Safeguards) Act 1987, and includes associated material (heavy water and graphite), associated equipment (eg, reactors, Zirconium tubes) and associated technology (enrichment technology).	
Proposed date		The action must not take place prior to approval. Note that approvals for consumption or dilution are typically returned within 7 working days after receipt of the application, but ASNO assessment of disposal plans can be extensive dependent on the application.	
Batch number / Item Identifier		
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).	
Any attributed Country obligations		
Provide details where known otherwise “unknown”.	
Containment		Describe type and size/volume of container. Eg. 100g bottle, 0.5 litre flask, within radiography camera.	
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.	
Item Classification		Determined by reference to the Classification Guide.	
Item status		Examples are draft, final, incomplete, operational, damaged	
Foreign obligation		The prescribed International Agreement which the item is subject to.	
Item description		For documents, include title and completion date.	
Practicably Irrecoverable		
Nuclear material in a state or condition where it would be more economical to produce similar material from scratch than to recover the material itself.	
Applicant’s Signature		
This form must be signed by a representative of the Permit Holder (i.e. the organisation) who will take responsibility and sign documents on behalf of the organisation.	

This form replaces the following forms 	ASO108 (revision 4 – issued 22 July 2010), ASO109 and ASO119