Ref. No.		
The Associated Item
	
Name of the Item:			
	
Unclassified description of the Item (for documents, include title and completion date):			
	
Facility address where the Item is located:			
	
Item status:		Item classification:			
	
Date of inventory change:		Inventory change code:			
	
Int’l obligation:			
	
Person(s) involved
	
Author(s), or person(s) responsible for construction:		Person(s) reproducing or destroying the item:			
	
Name of person authorizing reproduction or destruction		Classifier’s name:			
	
Supplier/recipient details
	
Is this Item leaving the facility (ie, a shipment)?		OR	entering the facility (ie, a receipt)?		
	
If a shipment, provide name and address of the recipient:			
	
If a receipt, provide name and address of the supplier:			
	
Carrier’s details
	
Carrier’s name and address:			

Signature
	
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).	
Associated Item		As defined in the Nuclear Non-Proliferation (Safeguards) Act 1987, and includes associated material (heavy water and graphite), associated equipment (eg, reactors, Zirconium tubes) and associated technology (enrichment technology).	
Item status		Examples are draft, final, under construction, stored, in operation, damaged, etc.	
Item classification		According to a Classification Guide	
Inventory change code		
As specified in the Accountancy and Control system, including codes for creation, receipt, dispatch, reproduction, destruction, change in status, loss, or other removal from the inventory.	
Int’l obligation		If applicable, record the obligations that apply to the Associated Item, ie, obligation(s) arising as a result of the Item being supplied to Australia under the framework of prescribed international agreement.	
Name of person authorizing reproduction or destruction		

Applicable for Items being produced by the Permit Holder.	
Classifier’s name		Applicable for Items being produced by the Permit Holder.	
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 forms 	ASO305 (Original issued 1 January 2002)