ACCESSION FORM - Virus

Minerva Biolabs GmbH
- Laboratory -
Landhausring 7
D-12683 Berlin		 Telefon +49 (0)30 2000 4370
Telefax +49 (0)30 2000 4379
Online: www.minerva-biolabs.de
E-mail: info@minerva-biolabs.de
completed by Minerva Biolabs:
ACCESSION NUMBER:

DATE CULTURE RECEIVED:

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: Customer Nr.
Institution/company: P.O. Nr.
Shipping address: Phone:
E-mail: Fax:

Designation of the virus:

Scientific name and collection number of the host (if available):

Host range:

Is the virus temperate ( ) or virulent ( ) ?

Nucleic acid type of the virus:

Virus morphology (e.g. envelope, shape):

Plaque morphology:

Amount submitted (Titer):

Biological safety grade: ( ) L1 ( ) L2

Is the virus 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:

Conditions for viability testing:

Suitable host (please deposit host, too):

Methods for propagation of the virus (please give as much details as possible, if necessary use a separate sheet):

Harvest:

Conditions for preservation (If known, please specify conditions, e.g. growth medium, suspending fluid, cryoprotectant, etc.):

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

Date: Signature:

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