Ref. No.		
Which uranium isotope(s) are involved?	
	
235-Uranium?	 	233-Uranium?	 	235-Uranium + 233-Uranium?		
	
Material batch details - initial higher enriched	
	
Batch number:		Material category:		Material Balance Area = AS-			
	
Physical / chemical form:			
	
Irradiated material?		Any attributed Country obligations?
(leave blank if Nil)			
	
Element weight:		Isotope weight:		Uranium isotope =			
	
Material batch details - initial lower enriched
	
Batch number:		Material category:		Material Balance Area = AS-			
	
Physical / chemical form:			
	
Irradiated material?		Any attributed Country obligations?
(leave blank if Nil)			
	
Element weight:		Isotope weight:		Uranium isotope =			
	
Material batch details – blended batch
	
Proposed batch number:		Mat’l category:		Material Balance Area = AS-			
	
Physical / chemical form:			
	
Irradiated material?		Any attributed Country obligations?
(leave blank if Nil)			
	
Element weight:		235-U weight:		233-U weight
(if applicable):			
	
Description of the project
	
Project goal, and blending process:			
	
The project’s contact officer:		Contact phone:			
	
Facility address:		Proposed start date:			

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).	
Batch number / Item Identifier		
Either one or several items with the same chemical and isotopic composition, physical form. Provide individual item identifiers (eg serial numbers) where known.	
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).	
Any attributed Country obligations		
Provide details where known, otherwise “unknown”.	
Chemical / Physical form		
Provide chemical formula (or name if unknown) and describe physical form. Eg UF6 gas, UO2 powder, metal shielding block, thorium nitrate solution, etc. Common compounds are described for example in the Handbook of Chemistry and Physics and the Merck Index. Describe also purity of batch eg heterogeneous, variable, manufactured, standard etc.	
Element weight		This refers to the contained weight of nuclear material in the compound.	
Proposed start date		Approval must be obtained prior to commencement of the project. Note that approvals are typically returned within 14 working days after receipt of the application.	
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 forms 	ASO129 (Original version) - issued 5 March 2003