WEMA Products Testing License Application Form
- Company overview
Registered name
Telephone / FAX
E-mail / Website
Mailing address
City/Town / Province/State / Country
Principal place of business
CEO name and signature
TYPE OF BUSINESS: Please check as appropriate
Sole proprietorship / Limited liability company
Parastatal / cooperative
A company registered in the country of:
AFSTA membership / Yes / No / If Yes, Since
Membership to National Seed Association
Years in operation / Yes ____ No ____ If yes, since ______
Number of employees
Management Staff
Technical Staff
Sales Staff
Annual maize volume sales
Total (No. of 20kg bags)
Hybrids (No. of 20kg bags) / ______
Licensing experience
Years In-licensing
Years Out-licensing
- Breeding and development capacity
Company testing networks (locations and institutions)
Breeding stock (%age of hybrids from own pipeline vs. licensing from others)
- Certified seed production capacity
Annual Production Capacity
Certified seed (tons)
Seed storage capacity
Total storage (MT)
Cold storage (MT)
Irrigation capacity
No. of Hectares
%age of Production Capacity
- Seed Quality
Accreditation to ISTA, etc (include company ID.)
Routine Germplasm maintenance /purity testing capability (describe equipment, processes, overall quality management program)
- WEMA Products requested for testing
Name of hybrid (s) of interest ______
Designation of Parental lines ______
Additional information to support the Application (provide any additional information that the applicant would like to submit in the support of the application)
Date______By______
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Submit completed application forms to:
The Chair
WEMAApplication Review Committee
C/O AATF Deployment Unit
African Agricultural Technology Foundation
P.O. Box 30709-00100,Nairobi, Kenya
Tel: +254 20 422 3746/3742: Fax: + 254 20 422 3701
Email:
Confidentiality Statement
This document contains proprietary and confidential information. All data submitted to the WEMA Application Review Committee (ARC) is provided in reliance upon its consent not to use or disclose any information contained herein except in the context of its business dealings with your company. In the event the confidential information must be disclosed pursuant to judicial order or requirement of law, the Party to whom such order is directed shall immediately notify the other Party of such order or requirement and shall take all reasonable steps to limit such disclosure, and vice versa.
The WEMA ARC shall not disclose or communicate confidential information except to their employees who have a need to know the confidential information and any third party mutually authorised by the Parties, in writing, to receive the confidential information.
The WEMA ARC also agrees not to duplicate or distribute or permit others to duplicate or distribute any material contained herein without your company’s express written consent.
Your company retains all title, ownership and intellectual property rights to the materials and trademarks pertaining to it, contained herein, including all supporting documentation.
Each Party’s obligations of confidentiality described in this Agreement shall be binding throughout the duration of this engagement and for a period of five years following the expiration or termination of this Agreement.
NOTE:
Please note that once a seed company has been selected by the WEMA ARC to receive either WEMA hybrids or inbred lines, it need not complete the entire application form for subsequent products of interest. From the date qualification is granted, the provided data remains valid for three years and will be used in subsequent applications reviews as long as the company re-submits section H of the application form to request consideration for product available. The seed company also needs to confirm that the previous information is still valid.
WEMA Products Testing License Application Form – CONFIDENTIAL 1