Ref. No.		
What is this Request related to?	
	
A change to the Accountancy Plan?	
A change to the Security Plan?			
	Proposed date of effect of change(s)?			
	
Details about the proposed changes    if insufficient space, send attachments
	
Specify permit conditions that will be affected?	

		
	
Describe the proposed change(s): 	

		
	
What is the reason(s) for making the change(s)?	

		
	
What is the overall impact of the change(s) to the accountancy and security of the nuclear material or associated 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:			

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, 003-Rev.1).	
Accountancy Plan		
A document that identifies the processes to be used in—and the persons responsible for—the system of accountancy of the nuclear materials and/or associated items in possession of the permit holder.	
Security Plan		A document that identifies the integrated measures—and persons responsible for—the prevention of unauthorised access to, or malicious acts against, nuclear material, associated items, associated infrastructure, as well as the transport of same.	
Proposed 
date of effect		
Please allow 10 working days for the proposed change to be assessed and approved.	
Proposed 
Changes		Attach updated plans, procedures, and diagrams, as relevant,
For physical changes to the security measures already installed, a detailed description of the proposed changes must be submitted.	
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 form 	ASO134 (revision 2 issued 22July2010)