First Schedule (Section 7(2))
Application for GMO permit
Part I – General information
1.Information on applicantName of Applicant: __________________________Official Registration Number of applicant: __________________________Address: __________________________Tel.: ____________________ Fax: ________________E-mail address: ________________________2.Nature of request (Please tick as appropriate)Permit RequestCategory A | ☐ | Laboratory experimentation |
☐ | Greenhouse trial |
☐ | Small field testing |
☐ | Large field trial |
☐ | General release |
Category B | ☐ | Food and feedstuffs |
Category C | ☐ | Transit |
Category D | ☐ | Importation |
Category E | ☐ | Exportation |
Category F | ☐ | Large scale production |
Have you applied for a similar permit before?☐ Yes☐ NoGive outcome of decision if "yes"☐ Approved☐ RejectedApplying for a GMO permit shall not entitle the applicant not to apply for any licence, permit or approval as required under any other enactment.Give previous permit number ______________________________Has your proposal been given the clearance by your Institutional Biosafety Committee? ______________________________3.Nature of GMO☐ Plant☐ Micro-organism☐ Animal☐ Others, please specify __________________________4.ConfidentialityCan the decision be publicly released?☐ Yes☐ NoPart II – Specific information
5.Information on responsible party/principal investigator of proposed projectName of Responsible Person/Principal Investigator: ______________________________Name of Institution/Laboratory/Firm: __________________________Address: ____________________________Tel.: ____________ Fax: ______________E-mail address: __________________________Name of other persons involved in the project:(i)____________________________(ii)______________________________(iii)____________________________Background and experience of persons involved: __________________________________________________Title of project: __________________________________6.Description of proposed dealing__________________________________________________7.Duration of proposed dealingExpected date of commencement: ______________________________Expected date of completion: ____________________________8.Purpose and aims of proposed dealing__________________________________________________9.Justifications and benefits of the proposed dealing__________________________________________________10.Scale of projectVolume or area to occupy: __________________________________Will the material be destroyed after the experiment? ____________________________☐ Yes☐ NoIf yes, give details of proposed method to eliminate or remove the GMO from the test site upon completion of the experiment:__________________________________________________If no, give details of future plans: ____________________________________________________11.Description of infrastructure involved in execution of proposed dealingDetails on laboratory, greenhouse, storage and any other facilities involvedLocation of site (provide map of trial site): ____________________________________Facility type (laboratory, greenhouse, insectary, etc.): ____________________________________Physical containment level: ____________________________Date of registration of facility: ____________________________Registration number: ________________________________Date of recent inspection:12.Description of packing conditionsProposed method of packaging (if applicable): ____________________________________Description of labelling (attach label if available): ____________________________________Part III – Information on proposed dealing
13.Origin of GMOCountry of origin: ____________________ Port of Departure: ____________Port of Entry: ______________________Means of shipment☐ Air☐ SeaProposed mode of transport inland: __________________________Final Destination (if transit): ____________________________Information on Exporter:Name of Company: __________________________Address: ____________________________Contact Person: __________________________Tel.: ______________ Fax: ____________E-mail address: ________________________Please attach evidence to certify that the Exporter is an authorised dealer of GMOs.Information on Importer:Name: ______________________________Address: ____________________________Contact Person: __________________________Tel.: ______________ Fax: __________________E-mail address: ______________________________________14.Full description of the GMOPlant
Family name: __________________________Genus: __________________________Species: ____________________________Sub-species: ____________________________Cultivar/breeding line: __________________________Common name: ________________________________Give information on the mode(s) of reproduction of the plant: ________________________________Micro-organism:
BacteriumFungusVirusMycoplasmaName: ______________________________Genus: ______________________________Species: ______________________________Sub-species: ______________________________Strain: ______________________________Animal
Family name: ____________________________Genus: ______________________________Species: ________________________________Breeding line: ________________________________Others (Please specify)
15.Amount of GMOUnits, weight, volume: ____________________________________16.Details of productDescription of product: ______________________________________What are the benefits of the proposed GMO? ______________________________________Description of the gene introduced: __________________________________Method used in introducing the gene: __________________________________Has the product been tested/commercialised elsewhere? ______________________________________What are the results of the tests? ______________________________Provide evidence of the results of the tests: ______________________________________________How do you verify for the GMO concerned? ______________________________What potential hazardous or deleterious effects resulting from the trial release of the GMO can be anticipated?__________________________________________________17.Relevant publications on the GMO (Provide a list)____________________________________________________18.General information on GMO or derivatives to be introduced | Parent organism | Recipient |
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Scientific name | | |
Common name | | |
Commercial name | | |
Other designation | | |
______________Signature of Applicant______________DateFor official use only
Date received: __________________________Application No.: ________________________Approved or Rejected: ______________________If rejected, give reasons why ________________________________________________Permanent Secretary, Ministry of Agro-industry and Fisheries______________DateSecond Schedule (Section 7 (3))
Part A – Information on risk assessment of genetically modified organisms for contained, confined and general release
1.Identity of GMO________________________________________________2.BenefitsDescribe the benefits to be gained through the GMO, e.g. agronomic gains, improvement of nutritional quality or pest resistance, etc.:______________________________________________3.Nature of organism and novel genetic material3.1Identity of organism: ____________________________________Scientific name of parent organism: ______________________________Common name of parent organism: ______________________________Modified trait: ____________________________________3.2Is it known whether the unmodified form(s) have any adverse effect on:(i)Humans, animals or plants?________________________________(ii)Agricultural production?________________________________(iii)Any other aspect of the environment?______________________________________3.3Give a description of the genetic and resultant phenotypic modification of the GMO. Provide information on (i) the source of inserted DNA, (ii) the outline of the DNA construct, (iii) the nature and source of the vector and procedure used to introduce the gene and (iv) the extent to which it has been characterised:______________________________________________________3.4Is the gene inserted a pathogenic determinant capable of causing disease in human beings, animals or plants?__________________________________________________3.5Is the gene introduced stable?____________________________________________________3.6What is the frequency of reversion, that is, loss of genetic modification?________________________________________________3.7How do you verify for the presence of the gene?________________________________3.8Have similar tests/releases of similar GMOs been made before, either within or outside this country?__________________________________3.9What data is available to suggest that the introduced genetic trait has no deleterious effect in the long term upon the species into which it has been introduced or allied species or any other organisms or the environment in general?________________________________3.10Does the GMO differ from the parental or recipient organism (e.g. mode of reproduction, dissemination, survivability)?______________________________________If so, please give details:______________________________________________3.11What experimental results/information are available to show the probable consequences (positive or negative) of the release of the GMO? __________________________________3.12Does the GMO have any impact on(i)Human, animal, plant health?________________________________(ii)Agricultural production?__________________________________(iii)Target and non-target organisms?______________________________________(iv)The general ecology, biodiversity?__________________________________3.13Has a trial release been carried out in the country of origin of the GMO?____________________________________3.14Can the genetic trait be transmitted by means other than by normal reproduction?____________________________________3.15Has the introduced gene been shown to be toxic to animals and humans?__________________________________3.16Is there a risk of harm to the environment associated with the dispersal of the organism or the gene concerned?______________________________________________3.17List details of action proposed to be taken in case of an accidental release of the GMO from containment/confinement:________________________________________________4.Details of field trials and general release4.1Give the location, size of field trial(s) or release site(s) (provide map of site) as well as isolation distances from other trials:________________________________________4.2Describe the ecosystem including slope, climate, flora and fauna, presence of endangered species, including information on natural predators and parasites surrounding the field trial or release site:______________________________4.3List any sexually compatible wild relatives or cultivated plant species present around the trial or release site:__________________________________4.4Describe the barriers planned in order to segregate the experiment/trial release from the surrounding environment:________________________________4.5How will the supervision and monitoring be carried out during and after the trial release?____________________________________4.6Provide details of how the plant materials including wastes will be eliminated after the trial (herbicidal treatment, incineration, etc.):____________________________________________________4.7Provide contingency plans to deal with unforeseen circumstances such as cyclone, flood etc. during the course of the trial:____________________________________________________4.8Give the duration of the trial or release: ______________________________5.Additional information for genetically modified plantYou must also fill in this part if you are proposing to deal with a GMO that is a plant.5.1Information about the use of the parent plantState whether the parent plant has an extended history of cultivation and safe use:__________________________________5.2Information about any unintended pleiotropic effectsGive details of any undesirable effects on the parent plant that may result from expression of the transgene, or an associated insertion-related mutation, in the GMO (for example, reduced fertility, increased disease prevalence, production loss, grain shredding), including the likelihood of any such events:______________________________________________________5.3Information about pollen and cross-pollination5.3.1Describe the mechanism of pollen spread (by insect vectors or by any other means) in the plant population:__________________________________________________5.3.2Give details of pollen viability for the parent plant and the GMO:__________________________________5.3.3Provide details of any potential pollinators for the parent plant and the GMO, and their range and distribution in Mauritius:__________________________________________________5.3.4Are quantitative data available on successful cross-pollination between the parent plant, the GMO and its wild relatives?__________________________________________________5.3.5List only sexually compatible plants near the site of the proposed release and provide details of the quantity and the chances for cross-pollination with the GMO:______________________________________5.3.6If cross-pollination with the GMO were to occur, provide details of the likely resulting plants and an assessment of whether they would survive and compete well with unaffected plants: ____________________________________________________5.4Information about weeds5.4.1List members of the family of unmodified parent plants that are known to be weeds in any environment:__________________________________5.4.2Give details of cross-pollination between the species to which the GMO belongs and relatives known to be weeds, including a copy of any peer-reviewed reports that support the information:__________________________________5.4Information about the possible result of the imparted characteristics being integrated into other species5.5.1State whether the novel characteristics of the GMO could be integrated into other species and if so, provide details of its potential to affect:1.the distribution and abundance of populations of the affected species; and2.factors that normally control populations of the affected species in the environment (for example, pathogens, herbivory and physiological stress)________________________________________________5.5.2List any other possible adverse consequences:______________________________5.5.3Give details of proposed measures to minimise the risk (for example, by imparting male sterility or other means of reproductive isolation):________________________________Part B – Information on risk assessment of food and feedstuffs derived from genetically modified organisms
1.Description of the GMO1.1Name of GMO from which the Food and Feedstuffs are derived:________________________________1.2Give a description of the genetic and resultant phenotypic modification of the GMO:__________________________________________1.3Describe (i) the source of the inserted DNA, (ii) the outline of the DNA construct, (iii) the vector and procedure used to introduce the gene and (iv) the extent to which it has been characterised:__________________________________________1.4Which of the following characteristics have been introduced in the GMO?i.Pesticidal properties______________________________________ii.Resistance to plant pathogen____________________________________iii.Insect resistance______________________________________iv.Herbicide resistance______________________________________2.Food and feedstuffs2.1Describe the product derived from the GMO:______________________________________2.2What is the proportion of the GMO in the food/feedstuffs?______________________________________2.3What method can be used to verify that you have the desired GMO?______________________________________2.4What methods are to be used to test for batch to batch consistency?____________________________________2.5How does the food/feedstuff ingredient from the genetically modified plant differ from the same food/feedstuff ingredient derived from the unmodified host?____________________________________2.6Has the food/feedstuff derived from the GMO been shown to be substantially equivalent to an existing food or food component?__________________________________________3.Human and animal health3.1Has any adverse effect on health been demonstrated upon consumption of the food/feedstuffs derived from the GMO in humans and animals? Provide results of any trials carried out:____________________________________________________3.2Provide information of any toxic or allergenic effects observed from the consumption of the food/feedstuffs derived from the GMO:____________________________________3.3Could any toxic products concentrate in natural and human food chain?________________________________________4.Environmental safety4.1Has any adverse effect of the release of the GMO food/feed on environment been demonstrated?__________________________________4.2What are the precautionary measures forecast to prevent accidental propagation of the GMO (e.g. GM maize seed, germination and growing)?________________________________5.Labelling5.1Give the proposed commercial name of the product:________________________________5.2Describe the labelling details on packaging:______________________________________6.Additional relevant information6.1What are the measures to be taken in the event of the escape of the organisms in the product or misuse of the product:__________________________________________________6.2Give details of specific instructions or recommendations for storage and handling of the product including transportation inland:____________________________________________________