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 16A(1) of the Nuclear Non-Proliferation (Safeguards) Act 1987, to establish a facility described below, being a facility 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 facility’s design, and how that design facilitates the operation of the Australian safeguards system (see Instruction 3). 
**Provide diagrams, maps, floor plans, etc, to the extent necessary** (see Instruction 4)
	
(E)	Provide a description of how the facility’s design will facilitate the physical security of nuclear material, and/or an associated item(s), that is to be stored in the facility.  Provide diagrams, maps, floor plans, etc, to the extent necessary.  (see Instruction 4)
	
(F)	Record the facility’s construction schedule, and identify key milestones in the establishment of the facility.  (see Instruction 5)
	
(G)	What are the contact details for the person carrying responsibility for maintaining adherence to the construction schedule?
Street Address	Postal address	
		
Phone:	(	)		Fax:	(	)		
Email address:		
(H)	Provide the geographic street address, GPS coordinates, and GPS landmark/location-point for the facility (or facilities) being established.
Street address

	GPS Coordinates	GPS Landmark/Location point

	
	Latitude		South		
			
	Longitude		East		
			
(I)	What is the intended use of the facility, or facilities?

(J)	Is there any other relevant information?
	
(K)	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:		

(L)	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 (L). 
2.	Facility means:
(a)	A reactor, a critical facility, a conversion plant, a fabrication plant, a reprocessing plant, an isotope separation plant or a separate storage installation; or 
(b)	Any location where nuclear material in amounts greater than one effective kilogram (see note below) is customarily used.
3.	Australian safeguards system means the system of accounting for and control of nuclear material and associated items that is established by:
(a)	the Nuclear Non-Proliferation (Safeguards) Act 1987;
(b)	the Nuclear Non-Proliferation (Safeguards) Regulations 1987; and
(c)	orders and directions under section 73 of the above Act.

4.	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.
5.	ASNO must furnish design information about its facilities (including those being planned and constructed) to the International Atomic Energy Agency (IAEA) in accordance with Australia’s Agreement with the IAEA, and the Subsidiary Arrangements thereto.
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

NOTE - ‘effective kilogram’:
As used in Instruction 2(b) above, this is a special measure used in safeguarding nuclear material.  The quantity of nuclear material in effective kilograms is obtained by taking:
(a)	For plutonium, its weight in kilograms;
(b)	For uranium with an enrichment of 0.01 (1%) and above, its weight in kilograms multiplied by the square of its enrichment;
(c)	For uranium with an enrichment below 0.01 (1%) and above 0.005 (0.5%), its weight in kilograms multiplied by 0.0001; and
(d)	For depleted uranium with an enrichment of 0.005 (0.5%) or below, and for thorium, its weight in kilograms multiplied by 0.00005.