Ref. No.		
What type of facility?	
	
Does this application relate to an existing facility?	 	OR	a facility under construction?		
	
What is the proposed change?	
	
Provide details about the proposed change(s): 

Attach diagrams, maps, floor plans, etc, as required.			
	
Proposed start date:		Likely duration - in months			
	
	Has a previous application(s) been submitted covering some—or all—of this change? 			If YES, list Reference Numbers of previous application(s):			
	
Assessment of likely impact
	
Indicate (by ticking) if the proposed changes will affect any of the following:
(a)	The storage location for, access to, or use of nuclear material or associated items?	
(b)	The performance of facility-installed security measures?	
(c)	The performance of any IAEA-installed containment/surveillance equipment?		
	
If any of the boxes are ticked, provide an explanation:			

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

__________________________
For Director General ASNO	
Name :				
		
Position:				
Signature:	___________________________	Date:	____/____/________		
	(Amended) DIQ issued?		
	
Name of Permit Holder:		Permit number:			

Total enclosures = 		Number of pages =			

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)	
Proposed start date		Changes to the facility’s design must not commence prior to approval being granted. 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 form 	ASO131 (Version 1) issued 15 June 2004