PART A – Application	Ref. No.		
Details about the Transfer	
Proposed date of transfer:	
Import (from overseas)? 		Export (overseas)?		Domestic transfer?				
	
Are you the Sender?		…..or the Receiver?		

What is the Associated Item?	
	
Item name:		Item Classification:		Item status:			
	
Country of origin:		Foreign obligation:			
	
Item description:	

Packing location:		Proposed packing date:			
	
Receiver’s details
	
Name of receiver:		Permit No.(if applicable)			
	
Physical address:			
	
Proposed use of the Item after transfer:	

Details about the transfer / shipment
	
Name of carrier:		Carrier’s Permit No: 			
	
Transport Plan title and number:		Transport Plan reference:			
	
Location where responsibility transferred:		Point of departure from Australia (for Exports):			
	
Route including ETDs and ETAs	

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

For Director General ASNO	
Name :				
		
Position:				
	Signature:	___________________________	Date:	____/____/________		
	
Permit Holder:		Permit number:			

PART B – Confirmation of transfer	Must be faxed to ASNO by 12 PM on the next working day after the transfer.	

Actual date of transfer:			Name :			
	Signature :	______________________	Date :	____/____/________	
APPLICATION WITHDRAWAL			

Explanatory Notes

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).	
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 of transfer		
Transfer must not take place prior to approval being granted. Note that approvals are typically returned within 14 working days after receipt of the application.	
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.	
(Receiver’s) Permit No:		
This is not required if the receiver is Intellectual Property Australia	
Carrier’s Permit No		The carrier must hold a current appropriate permit granted under section 16 of the Nuclear Non-Proliferation (Safeguards) Act 1987	
Transport Plan		Provide name of transport plan approved under ASNO form ASO113	
ETD		means Estimated Date of Departure	
ETA		means Estimated Date of Arrival	
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 replaces the following forms 	ASO115 (version 2 - issued 19 March 2003), ASO118, ASO218 and ASO223