PART A – ACKNOWLEDGEMENT of RECEIPT	Ref. No.		
Listing of sealed goods	
	
		Item Description	Sample Type	Seal no.		
	1					
	2					
	3					
	4					
	5					
	
Date of receipt, and location at which goods received
	
Date:		Location:			
	
Handling requirements
READ HANDLING REQUIREMENTS ON THE BACK OF THIS FORM BEFORE SIGNING BELOW	

Declaration, signature and permit details	
	
I declare that:-
1)	all applied seals are intact at the time of receipt of the above listed goods; and
2)	an ASNO National Inspector has explained the important handling requirements—as listed on the reverse of this form-- regarding the sealed goods.	
Name :			
	
Position:			
	    Signature:	_____________________________________	Date:	____/____/________	
	
Permit Holder:		Permit No:			

 PART B – NOTIFICATION of SHIPMENT of SEALED GOODS	
Courier details – see reverse for actions required in relation to shipping documentation
	
Name of courier			
	
Shipment date:		Estimated date of arrival @ destination			
	
Signature 
	
I declare that the sealed goods listed in Part A above, were handed to the above courier with seals intact.  	
Name :			
	
Position:			
	    Signature:	_____________________________________	Date:	____/____/________	
	
Explanatory Notes

ASO232		Samples collected and sealed by the IAEA must be sent to the IAEA with seals intact. The Permit Holder may seek reimbursement for such services as provided for under Article 15 of Australia’s safeguards agreement with the IAEA (i.e. Australia’s “Agency Agreement”).	
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).	
Listing of sealed goods			The seal number details should be cross-checked by a separate person in order to minimise transcription errors.	
Handling requirements		•	The sealed goods listed in PART A of this form must be secured in a locked location before shipping;
•	The sealed goods must not be tampered with in any way;
•	Accidental seal breakage must be reported to ASNO immediately;
•	Authorisation must given by ASNO before additional access to the contents of the sealed goods can be granted;
•	Sealed goods must be sent to the destination address requested by the ASNO National Inspector, or IAEA Inspector; 
•	If the sealed goods exceed the quantities listed below:
•	 the courier must hold a current appropriate special transport permit granted under section 16 of the Nuclear Non-Proliferation (Safeguards) Act 1987; and
•	 a separate Form ASO106 must also be submitted to ASNO prior to export.
Material Type	
Quantity Limit	

enriched uranium or plutonium	
1 gram	

natural uranium (including UOC)	
500 kilograms	

depleted uranium or thorium	
1000 kilograms	

•	Upon the sealed goods being handed to the courier, PART B of this form must be completed and forwarded to ASNO within four hours.	
Shipping documentation		All associated shipping documentation must be sent to ASNO via fax, mail or as email attachments within two business days.	
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.