Ref. No.		
Physical Inventory Taking (PIT) details	
	
Proposed date for the PIT:		Location of PIT:			
	
Individual(s) to carry out the PIT:			
	
Nuclear Materials / Associated Items to be inventoried:			

Signature and permit details	
	
Name :			
	
Position:			
	Signature:	_____________________________________	Date:	____/____/________	
	
Permit Holder:		Permit No:			

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).	
Proposed date for the PIT		
This notification shall be submitted to ASNO at least ten working days prior to the proposed date.	

		

		

		

		
This form replaces the following forms 	ASO213 (Original issued 1 January 2002)