TO:	The Director General,
	Australian Safeguards and Non-Proliferation Office

	The following application is hereby made for the granting of a permit under sub‑section 16(1) of the Nuclear Non-Proliferation (Safeguards) Act 1987, to transport the associated item(s) described below, being associated item(s) to which Part II of that Act applies.

– PLEASE READ THE INSTRUCTIONS ON THE LAST PAGE –

(A)	What is the name of the applicant? (see Instruction 1)
		
	ABN / ACN:			
		
(B)	Provide a short description of the business or activity of the applicant
	
(C)	What are the applicant’s contact details?
Street Address	Postal address	
		
Phone:	(	)		Fax:	(	)		
Email address:		
(D)	Provide a description of the associated item(s), including any identification or markings	(see Instruction 2)
	
(E)	List each associated item(s) to be transported, including any markings/identification?  
(see Instruction 3)
	
(F)	Who is/will be the consignor(s) and consignee(s) of the associated item(s)?
Consignor(s)		Consignee(s)	

	

Permit number:				Permit number:			

	

Permit number:				Permit number:			

	

Permit number:				Permit number:			
			
(G)	Locations involved?
Pick-up address(es)		Destination address(es)	

			

			
			
(H)	What means of transportation will be used, and what is the transport route? Provide a map showing the route. (see Instruction 5)
	
(I)	What measures will be taken to prevent theft, loss or unauthorised use of the associated item(s) (provide diagrams or photographs where necessary)? (see Instruction 5)
	
(J)	What procedures will be implemented to generate accurate accounting records for the associated item(s)?
	
(K)	Is this application for a permit related to a single transportation event, repeat events or multiple events? (see Instruction 5)
Single event		Indicate dates or time period:		
Repeat event(s)		Provide details:	

	
Multiple events(s)		Provide details:	

	
(L)	Is there any other relevant information?
	
(M)	What is the name, address and telephone number of the person authorised by the applicant to provide additional information in relation to this application?
Street Address	Postal address	
		
Phone:	(	)		Fax:	(	)		
Email address:		
(N)	SIGNED BY, OR ON BEHALF OF, THE APPLICANT:
** The signatory below must have organisational authority to represent the applicant and to implement the conditions of the permit when granted **
	
Name :			
	
Position:			
	    Signature:	_____________________________________	Date:	____/____/________	

INSTRUCTIONS

1.	If the application is being made by, or on behalf of, a corporation, organisation or legal entity, the name of the corporation, organisation or legal entity is to be inserted at question (A).  Do not insert the name of the person signing the application; this must happen at question (N). 
2.	Associated item(s) means any of the following:
(a)	Associated equipment means equipment or plant that:
(i)	is specially designed, manufactured or built for use, or is specially suited (whether with or without modification or adaptation) for use, in:
(A)	nuclear activities; or
(B)	the production of nuclear weapons or other nuclear explosive devices; and
(ii)	is included in a class of equipment or plant that is declared by the Minister, in writing, to be associated equipment for the purposes of this definition;
The above also includes a component or part of such equipment or plant.
(b)	Associated material means any material (other than nuclear material, associated equipment or associated technology) that:
(i)	is of a kind specially suited for use in nuclear activities, the construction of a nuclear reactor or the production of nuclear weapons or other nuclear explosive devices; and
(ii)	is included in a class of material that is declared by the Minister, in writing, to be associated material for the purposes of this definition.
(c)	Associated technology means any document that contains information (other than information that is lawfully available, whether within Australia or outside Australia and whether for a price or free of charge, to the public or a section of the public):
(i)	that is applicable primarily to the design, production, operation, testing or use of:
(A)	equipment or plant for:
•	the enrichment of nuclear material;
•	the reprocessing of irradiated nuclear material; or
•	the production of heavy water; or
(B)	nuclear weapons or other nuclear explosive devices; or
(ii)		to which a prescribed international agreement applies and that is of a kind declared by the Minister, in writing, to be information to which this definition applies;
The above also includes any photograph, model or other thing from which such information may be obtained or deduced.
3.	Where there is insufficient space on this form to furnish complete information, additional information must be provided on separate sheets, numbered consecutively and signed by, or on behalf of, the applicant.
4.	Where both the consignor and the consignee are located in Australia, each should have a permit granted under sub-section 13(1) of the Nuclear Non-Proliferation (Safeguards) Act 1987 to possess the associated item(s). The numbers of those permits should be inserted at questions (F) and (G). Where the application is in respect of the export or import of the associated item(s), the permit number of the consignor or consignee located in Australia only is requested. 
5.	‘Repeat events’ means those events that have the same pick-up and delivery address.  ‘Multiple events’ means any number of pick-up locations, with any number of possible destinations, and in no particular order of pick-up and delivery.
6.	To expedite the application process, the applicant may send information electronically in the first instance, and then post the originals, noting that the application cannot be completed until the original posted documents are received by ASNO. ASNO’s contact details are:
Phone:	(02) 6261 1920
Facsimile:	(02) 6261 1908
Email:	nuclear.asno@dfat.gov.au
Postal address:	The Director General
	Australian Safeguards and Non-Proliferation Office
	R.G. Casey Building
	John McEwen Crescent
	Barton ACT 0221