1 Start 2 Complete REQUESTOR INFORMATION Principal Investigator PI Name: * PI Phone: * PI Email: * PI Department: * Contact Person Contact Name: * Contact Phone: * Contact Email: * ORDERING INFORMATION Preferred arrival location (after quarantine): * Ethical Approval Number of Research: * Please attach a copy of the approval letter More informationFiles must be less than 2 MB. Allowed file types: gif jpg jpeg png pdf doc docx. Upload approval letter * Budget Number to be charged: * For estimate charges (import, cages in quarantine, health monitoring tests and cesarean section if needed) please contact the ABBM office - 88465 , abbmorders@savion.huji.ac.il DESCRIPTION OF CRYOPRESERVED STRAINS Complete for each strain. Please fill a separate table if more than one strain is to be imported. Species: * Mice Rats Other Species Other * Kind: * Tg KO KI Other Kind Other * Number of straws/ vials: * Sperm: * Embryos: * Strain Name: * Background strain: * Special Conditions: * Characteristic of the GM strain: * Immune Status: * Normal Undetermined T cell deficient B cell deficient Other Immune status Other * Can this strain/species be obtained from a commercial source? * Yes No + + Add another animal specie DESCRIPTION OF CRYOPRESERVED STRAINS 2 Complete for each strain. Please fill a separate table if more than one strain is to be imported. Species: * Mice Rats Other Species Other * Kind: * Tg KO KI Other Kind Other * Number of straws/ vials: * Sperm: * Embryos: * Strain Name: * Background strain: * Special Conditions: * Characteristic of the GM strain: * Immune Status: * Normal Undetermined T cell deficient B cell deficient Other Immune status Other * Can this strain/species be obtained from a commercial source? * Yes No Signature of Principal Investigator * SENDING INSTITUTE INFORMATION Name and address of Institution from which animals are to be obtained: * Collaborating Principal Investigator from the exporting institution Collaborating PI Name: * Collaborating PI Phone: * Collaborating PI Email: * Contact person from exporting institution Contact Name: * Contact Phone: * Contact Email: * Institutional Veterinarian Vet Name: * Vet Phone: * Vet Email: * Animals to be shipped are located in Facility: * Unit: * Room: * Important information regarding the cryopreserved sperm/ embryos shipment• cryopreserved sperm/ embryos approval is valid for 30 days. In case of delay, re-approval of health status and shipment is needed.• The shipment should arrive between Sunday morning and Wednesday night.• A proforma invoice for customs purpose including description, quantity and values is to be filled out.• The shipment is to be accompanied by a government veterinary certificate.• Germplasm is very sensitive to temperature changes therefore it is best if delivered in Dry shipper containing LN2. • Please instruct the sender to send the shipment of sperm/embryos in a dry shipper directly to ABBM-GEMM address Submit
