Ref. No.		
Who is the authorised recipient?	
	
HONEYWELL / CONVERDYN?	
CAMECO?	
COMURHEX?		CAEA?	
Other?		
	If “Other”, please specify:			
	
Details about the materials
	
Estimated U3O8 weight  in kg:		Number of containers:			
	
End Users
(if known):			
	
Shipping route, and details
	
Specify all transit points:	

	ETD	Port/Place of Departure	ETA	Port/Place of Arrival	Vessel (or “road/rail”)	Name of CARRIER		
					Name	IMO No.			

									

									

	ASNO use only	
Applicant’s signature, and permit details	Receiver has confirmed safeguards will apply		
	Approved:	____/____/______

__________________________
For Director General ASNO	
Name :				
		
Position:				
	Signature:	_______________________________	Date: ____/____/_______		
	YC-	
	Faxed to DRET		
	
Name of Permit Holder:		Permit number:			

Explanatory Notes

This application must be lodged with ASNO not less than 7 calendar days prior to export.

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, 003 Rev 1).	
Vessel		All vessels departing Australia must be approved by the Director using ASNO form ASO111	
ETD		means Estimated Time of Departure	
ETA		means Estimated Time of Arrival	
Carrier		means the name of the shipping line using the vessel, or name of company for road/rail movements.	
Applicant’s signature	This form must be signed by a representative of the Permit Holder (ie, the organisation) who will take responsibility for, and sign documents on behalf of, the organisation	This form must be signed by a representative of the Permit Holder (ie, the organisation) who will take responsibility for, and sign documents on behalf of, the organisation.	

This form replaces the following form 	ASO110 (Version 9 – issued 16 February 2009)