PNCM

Philippine National Collection of Microorganisms
National Institute of Molecular Biology &
Biotechnology (BIOTECH)
University of the Philippines Los Baños UPLB
College, Laguna 4031, Philippines

ACCESSION NUMBER:
BIOTECH
Date of Acceptance:

FILAMENTOUS FUNGI AND YEAST DEPOSIT FORM

(ex. Fungi010206)

1. Name of Organism:

Scientific Name:
Author(s):
Strain designation:
Classification: Order
Family:

2. Origin of the Strain:

Isolated by:
Date:
Date:
Substrate or host:
Geographic source
Location of herbarium specimens:
Culture also deposited at:
Identified by:
Date:

3. History of the maintenance of the organism (If you did not isolate this strain, please indicate
the sequence of laboratories which maintained this strain until the time you deposited it with us and their strain designation).

PNCM

Contributor

Origin

4. Reason(s) for Deposit:

New taxon:
Special use (assay or production):
Special characteristics:
Others:

5. Cultivation of the Strain:

Growth medium (please attach formula):
Temperature:oC dark/light: Incubation time:


Sporulation/fructification medium (please attach formula):
Temperature: o C dark/light: Incubation time:


Type of fruiting structures:
Unusual maintenance requirements:

6. Does this organism survive:

Lyophilization?	Yes.	No.
Freezing?	Yes.	No.

7. Safety Information:

Is this strain hazardous to:

humans
animals
plants
unknown

If yes, what is the required biosafety level for working with this culture?
Does this agent require any special permits?

If yes, please specify.:

8. References or reprints pertinent to the organism (If not available please attach a complete description of the organism):

9. Patent No. (if there is any):

10. Remarks:

11. Legal Status of Deposit (Adapted and modified from ATCC) Check either a or b to determine the conditions under which the culture is deposited at PNCM

12. PNCM may, in accordance with its current procedures and resources, authenticate (if appropriate) and preserve the Material.

13. THIS FORM STATES THE ENTIRE AGREEMENT BETWEEN THE PARTIES REGARDING THE MATERIAL. THE UNDERSIGNED IS/ARE AUTHORIZED TO EXECUTE THIS AGREEMENT.

Contributor	Duly Authorized for Contributor’s Institution (if required)
Signature Date	Signature Date
Printed Name and Title	Printed Name and Title
Institution	Institution
Mailing Address	Mailing Address
Telephone	Telephone
Fax E-mail	Fax E-mail