Ref. No.		
What is this Application about?	
	
Putting nuclear material to non-nuclear use?	
Production of the isotope  233Uranium		Separating fission product from nuclear material?		
	Earliest date for the new project?			
	
Details about the proposed feed material
	
Batch number:		Item identifier:		Material category:			
	
Materials Balance Area:		Any attributed Country obligations?		Which Country?
(leave blank if Nil)			
	
Physical form:		Is this material irradiated?		
	
Chemical form:		Material Description Code:			
	For  enriched  uranium	
Element Weight:		Kg	
Grams		235U grams		233U grams:			
	
Details about the project   refer to the Explanatory Notes on the reverse of this form
	
The project’s formal title:			
	
Project leader’s name: 		Phone contact details:	(	)		
	
The goals of the project:			
	
Location of project?	
		
Describe, as relevant,  (1) the purpose of the project, (2) the processes used, (3) descriptions of the final products, and (4) likely quantities produced:	 -- PROVIDE ATTACHMENTS AS REQUIRED --	

		

Applicant’s Signature	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, 003-Rev.1)	
Earliest date the route would be used		
This application must be lodged with ASNO not less than 20 working days prior to the date of the route being used, and the route must not be used before ASNO approval is granted.	
Location of project		Address, Building and Room number of the project’s location	
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 	ASO126 (Version 1 issued 22 July 2010), ASO127 and ASO130