www.agridept.gov.lk

1. Full name and address of the importer:
2. Name and address of supplier:
3. Description of the material to be imported
   Scientific name:       Life stage:           Quantity:
4. Whether the organisms are natural, genetically modified or living modified:
5. Country and locality of origin:
6. Means of importation: Air-freight/ Sea-freight/ Air mail/ Accompanied baggage
7. Port of entry:
8. Approximate date(s) of entry into Sri Lanka:
9. Nature of phytosanitary and or zoosanitary cover and other certifications on the consignment:
10. Precautions taken regarding the purity of the organism:
11. Purpose of importation
12. Authority responsible for studies with the imported organism:
13. Venue of studies:
14. Testing procedure:
15. Information regarding any previous importation of the same organisms by the applicant:
16. Information on any previous studies done on behalf of the applicant using the same organism:
17. Whether details of the organism as required in the QP/42 are annexed:

I do hereby declare that the above information is true and correct. I undertake not to ship the material before obtaining the permit. If an Organism Importation Permit is issued on my behalf for this request, I accept to comply faithfully with the conditions laid down in such permit.



Date:
Signature of the applicant: