Ref. No.		
CREATE new Approved Location		REMOVE existing Approved Location		 
Location details

Street address:	
	
Building number (if applicable):	

	

Other relevant descriptive details:	

	

Date and type of material to be held or removed	
	
Nuclear material		

Associated items		•	Earliest date the location would be used:
OR
•	Date nuclear material and/or associated items permanently removed from site:			
	
For new Location only: Material/Item details 
	
Maximum quantity of material to be held at new location:		Kg 	
grams		Material category:			
	
Description of item/materials to be used at new location:			
	
Proposed use of the item/material:			
	
For new Location only: Control measures to be applied to new Location
	
Describe the proposed  accountancy and control procedures:			
	
Describe the proposed  security arrangements:			

Map and floor plan attached	
Applicant’s signature, and permit details	ASNO use only	
	Approved:	____/____/______

Signature:		

Approver:			
Name:				
		
Position:				
	Signature:	.............................................................	Date:___  /____/____		
	Additional conditions:   Yes     No	
Permit Holder:				
		
Permit No:				
	
Explanatory Notes

Unless otherwise specified by ASNO, please submit this form by email attachment to nuclear.asno@dfat.gov.au.

Ref No		A sequential reference number is required for each form of this type submitted by the Permit Holder in a calendar year (eg 2021-001, 2021-002 etc). Where amendments are made to a previously submitted form, please use the same reference with a sequential revision number (eg 2021-002 Rev 1).	
Location details		Where applicable, include building name, or building number (eg warehouse or building number in industrial site). The applicant must maintain effective control over approved locations.	
Associated items		As defined in the Nuclear Non-Proliferation (Safeguards) Act 1987 Includes associated material (heavy water and graphite), associated equipment (eg, reactors, Zirconium tubes) and associated technology.	
Earliest date the new Location would be used		

Approval must be granted before nuclear material or associated items are introduced into the new location. Approvals are typically granted within:
(a)	7 working days for proposed locations holding nuclear material; and
(b)	20 working days for proposed locations holding associated items.	
Date nuclear material and/or associated items permanently removed from site		

Approval will not be granted until all nuclear material and/or associated items are permanently removed from the site being removed as an approved location.	
For new location only:	
Maximum quantity of material to be held at location 		

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.	
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).	
Proposed use of the item/material		
For example, “Storage”, “Research”, “Industrial Radiography”, “Environmental Tracer”, or “Production of medical isotopes”.	
Updated control measures to be applied to the proposed Location		

Plans and procedures should be attached as applicable. If adding a new location to an existing permit, you may refer to existing accountancy and control procedures under that permit. For security arrangements, you may refer to the State issued licence for the new location.

Accountancy and control procedures, and the security arrangements, shall be fully implemented prior to any nuclear material or associated items being held at the new Approved Location.

A map or other relevant information clearly identifying the proposed location is to be attached to this form as part of the formal application.	
Applicant’s signature		This form must only be signed by an individual authorised by the Permit Holder(s) to provide this application. (Electronic or digital signatures are permitted)