1. Variety name:

2. Parents name:

3. Species name:

4. Botanical taxonomy:

5. Name, address, phone and fax

of the institution from which document is demanded:

6. Name, address, phone, fax of the breeding institution:

7. Name, address, phone, fax of the

demanding person/institutionthe document:

8. Name, address, phone, fax of the paying fee:

9. The purpose of demanding the document:

a.      Variety protection

b.      Registration

c.       Standard seed registration

10. File number in demanding institution (if):

11. Date:

12. Signature: