ACCESSION FORM - Cell lines

Please note: Minerva Biolabs only accepts sample extracts of organisms with laboratory containment no higher than level 2 (L2) and genetic safety no higher than level 1 (S1) according to the regulations of the GenTG. Biological safety levels must be indicated to be accepted.

Name of the cell line:

Collection number (if available):

Cell type:

Source of isolation:

Properties of the cell line (Results of morphological, biochemical, genetic, serological or other examinations. Please give as much information as possible and/or give references):

Is the cell line dangerous to health or environment?

a. - it is pathogenic for humans: ( ) YES ( ) NO ( ) UNKNOWN

b. - it is pathogenic for animals: ( ) YES ( ) NO ( ) UNKNOWN

animal species:

c. - it is pathogenic for plants: ( ) YES ( ) NO ( ) UNKNOWN

plant species:

Cultivation conditions:

Morphology:

Medium:

Subculture:

Doubling Time:

Harvest:

Special requirements (light, gas phases, etc.):

Special conditions:

Conditions for storage:

Is the cell line genetically maipulated? If yes, please complete the following !

Data concerning the:

HOST ORGANISM

Hazard group: ( ) haz. gr. 1 ( ) haz. gr. 2

Biological safety grade: ( ) L1 ( ) L2

Sensitivities:

Resistances:

Auxotrophies:

Special properties: (e.g restriction/modification system, general genetic recombination)

DONOR ORGANISM

Hazard group: ( ) haz. gr. 1 ( ) haz. gr. 2 ( ) haz. gr. 3

Description of the cloned DNA fragment:

Size of the cloned DNA: ( ) complete genome (in bp)

( ) subgenomic

( ) subgenic

Potential risk of the cloned DNA: ( ) no potential risk ( ) pathogenic

( ) tumorigenic ( ) toxigenic

( ) allergenic

VECTOR

Designation:

Derivative of:

Biological safety grade: ( ) L1 ( ) L2

Host specificity:

Resistances:

Plasmid/virus size:

Promoters:

Additional reading frames:

own infectiosity: ( ) yes ( ) no

mobilisable plasmid: ( ) yes ( ) no

own transfer system: ( ) yes ( ) no

transfer by endogenous helper viruses: ( ) yes ( ) no

Genetically manipulated cell line

Special properties:

Foreign DNA: ( ) chromosomally integrated ( ) episomal

Potential risk: ( ) pathogenic ( ) tumorigenic

( ) toxigenic ( ) allergenic

( ) no potential risk, please indicate why:

According to the regulations of the GenTG* Minerva Biolabs can only accept genetically manipulated, potentially pathogenic cell lines when a copy of the permit issued by the competent authority (or by an equivalent national biological safety commission) for work on the cell line accompanies this form.

* GenTG = Gesetz zur Regelung von Fragen der Gentechnik (German law for the regulation of questions concerning genetic engineering)

NOTE: I understand that the submitted cell line will be subcultured and a back up sample stored for my convenience for 1 year at the discretion of the Minerva Biolabs.

NO CELL LINE IS ACCEPTED UNLESS MINERVA BIOLABS HAS RECEIVED THIS SIGNED FORM!