Application form for seed provision from

the Imperial Tobacco Nicotiana collection

The completed form must be signed and sent to:

1)Details of the Applicant
  1. Name of the Applicant
/ Click here to enter text
  1. Name of the Institution
/ Click here to enter text
  1. Nature of the Institution
/ Non-profit ☐ Commercial ☐
  1. Address
/ Click here to enter text
  1. Phone number
/ Click here to enter text
  1. email
/ Click here to enter text
2)Import rules in force in the country of the Applicant (outsideEU)
Click here to enter text
3)References andnamesof requested seeds (0.1g per accession)
Click here to enter text
Click here to enter text
Click here to enter text
Click here to enter text
Click here to enter text
4)Detailed descriptionof the intended useof the requested seeds
Click here to enter text

Terms and Conditions for the provision of seeds

  1. The seeds are provided by Imperial Tobacco Limited after examination and acceptance of the use intended by the Applicant.
  2. The Applicant is allowed to use the seeds only in the framework of the use described in 4).
  3. The seeds are not certified, no complaint canbe made regardingthe quality of theseeds supplied.
  4. Imperialtobaccolimited is notresponsible for delaysin the deliveryby the carrieror customsoperations.
  5. If the Applicant decides to patent genes or molecular markers obtained with the nicotiana varieties provided by Imperial Tobacco Limited, the Applicant agrees to grant a free license to Imperial Tobacco Limited, which may grant sub-licenses to its partners that have a scientific agreement to develop new tobacco varieties.
  6. The seedscovered bythe provisionwill not begiven or re-sold to third parties.
  7. On completion of the work related to the demand described in 4), the remaining seeds will be destroyed or returnedto Imperial Tobacco Bergerac, La Tour, F-24100 Bergerac.
  8. The Applicant can publish freely the results obtained with the provided seeds.
  9. This form signed by the two parties acts as acontract betweenImperial TobaccoLimited andthe Institutionof the Applicant.
  10. The Applicant agrees that any litigation shall be subject to the exclusive jurisdiction and venue of the courts in England and Wales. The Applicant agrees that any such proceeding shall be conducted in English.

In signing this form you confirm your agreement with the Terms and Conditions set out above.

Date and place Date and place

Click here to enter text

For the Applicant,For Imperial Tobacco Limited,

Name (Printed)Name (Printed)

Click here to enter text

SignatureSignature

1/2