Ref. No.		
Classified item details	
	
Item name:		Item Classification:		Item status:			
	
Country of origin:		Foreign obligation:			
	
Item description:	

Reason(s) for seeking this exemption
	
Explain why it is not practicable to mark this item:	

		

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

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

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)	
Classified item		An associated item that has been classified through reference to a classification guide.	
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).	
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.	
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 form 	ASO124 (Original – issued 1 January 2002)