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ANIMAL EXPERIMENTATION ETHICS COMMITTEE APPLICATION FOR A NEW STRAIN OR HYBRID OF A GENETICALLY MODIFIED ANIMAL Section 3.3.56 to 3.3.63 of the Australian Code gives the requirements regarding genetic modification of animals. This application form must be completed for the production of a new strain or hybrid of a genetically modified animal. All projects involving the genetic modification must meet the requirements and guidelines of the OGTR. A hybrid is defined as a cross between genetically unlike individuals. Date………………… 1. Approved Proposal Number (If pending insert ‘pending’): 2. Name and contact details: 3. Genetic modification intended: 4. Reason for creating the genetically modified animal (3.3.57): 5. Potential impact on the animal, including any potential harmful side effects on the parent animal or offspring (3.3.57 and 3.3.58): 6. Means that will be used to deal with any potential side-effects of genetic manipulation that may impact negatively on the welfare of the animal or offspring (3.3.58): 7. Details of monitoring of animals (3.3.58): 8. Details of specialist needs of animals and specialist care that may be required to minimise impacts. Please also define humane endpoints(3.3.59): AEEC/App New Strain or hybrid.rtf 2 9. If procedures are to be performed to determine the genotype of transgenic animals, details of the investigator who will perform these procedures and their experience (3.3.63): DECLARATION: I will notify the ANU AEEC immediately concerning any deviation from predictions made in this proposal and I will maintain records relative to the stability of the phenotype of the animal and also those relative to mortality, morbidity and population health. I will provide a final report to the ANU AEEC at the completion of this project (3.3.60). Signature aeec/Biomedical App Form.rtf 2003