Agreement & Registration FormCell lines are distributed to qualified investigators for use in their research. The investigator is asked to sign forms stating that:
DISCLAIMER OF LIABILITY FOR THE SUPPLIES OF CELL LINES TO INVESTIGATORS (S) THROUGH THE NATIONAL CENTRE FOR CELL SCIENCE, PUNE I confirm while procuring the cells from NCCS that I accept the responsibility for any injury (including any injury resulting in death) , damage or loss that arise from the use of the above stated cells or their progeny. I will not hold the originator of the cell line and the present supplier i.e. NCCS, Pune responsible for the damages as stated above. I also confirm that above stated cells should be handled with precaution in appropriate biosafety cabinet facility which is available in the Laboratory.
Name and signature of the investigator(s) Date
Name and Address of the Institute Signature and Seal of the Head of the Department/ Institute
STATEMENT OF AGREEMENT FOR SUPPLIES OF CELL LINES BY NATIONAL CENTRE FOR CELL SCIENCE, PUNE If your organization plans to obtain cell line/s from NCCS , please sign this agreement form and return to us. I hereby agree that the cell line/s provided are for research purpose only. The cells and their products shall not be sold or used for commercial purposes. The cells shall not be distributed further to the third parties for any purpose without the approval of NCCS. I also confirm while procuring the above stated cells from NCCS that I accept the responsibility for any injury, damage or loss that arises from the use of the cells or their progeny. I will not hold the originator of the cell line or the present supplier i.e. NCCS , Pune responsible for the damages as stated above.
Name and signature of the Institutional Authority Date
Name and address of the Institute
REGISTRATION FORM TO BE FILLED PRIOR TO PROCUREMENT OF CELL LINES FROM NCCS
Institute / Organisation
Address
Telephone Numbers Facsimile Number E-mail Address
Category (please ü ) Institute / Organisation Activity
Laboratories / Departments of your organization to whom the service for culture supply can be extended.
List of facilities available for handling cultures (including biosafety containment facility)
Registration for procurement of (please ü ) q Primary Cultures q Hybridomas q Established cell lines (non hazardous) q Obligate intracellular parasite q Established cell lines q Plasmids, Vectors etc.
I hereby accept the full responsibility towards procuring , processing and handling of the above stated material supplied by NCCS and will not hold the Originator of the material or the depositor or supplier to NCCS and/or NCCS responsible for any damage or loss, either directly or indirectly.
I also grant permission for inspection of the facilities for handling cultures, laboratories by the Member of Biosafety and Ethical committee appointed by NCCS and / or Department of Biotechnology, Government of India.
Date
Signature/Name/Designation Mail back to :- The curator National Centre for Cell Science NCCS Complex , Ganeshkhind Pune 411 007 , Maharashtra, INDIA Phone: 91-20-25690922, 25690941/51/61,25692256,25692257 Fax: 91-20-25692259 Email: infonccs@giaspn01.vsnl.net.in; patole@nccs.res.in;
|
|
|
