ACCESSION FORM FOR DEPOSIT

LABORATORY PROCEDURES FOR ANIMAL & HUMAN CELL LINES

Appendix

REFERENCE NO: AHC/1998/2/1.1 Appendix 2.1

TITLE: ACCESSION FORM FOR DEPOSIT - DSMZ

DSMZ use only

DATE CULTURE RECEIVED:

ACCESSION NUMBER: DSM

DSMZ ACCESSION DATE:

COLLECTION OF HUMAN AND ANIMAL CELL LINES

ACCESSION FORM

For completion by the depositor:

1. DEPOSITOR INFORMATION:

Name of Depositor:

Institute:

Department:

Address:

Telephone: Telefax:

Address, telephone and telefax, where additional technical enquiries can be made (if different from above):

Name:

Address:

Telephone: Telefax:

2. ORIGIN OF CELL CULTURE:

Name of cell line:

Source of cells (donor species, race, strain, sex, age, adult/embryonal, normal/malignant, organ or tissue, blood type) :

If hybridoma:

immunized animal: species:

strain: myeloma designation:

antibody specificity/subclass: secretion stable: ( ) yes ( ) no

HISTORY OF CELL LINE:

Name of originating or deriving investigator:

Date of origin:

References: (original description or other appropriate publications:

Cell line deposited elsewhere: ( ) yes ( ) no

If yes, where and reference no:

CELL LINE DESCRIPTION:

Morphology:

Ploidy:

Special characteristics:

Limited lifetime in-vitro:

KNOWN CONTAMINATION and PATHOGENICITY

Mycoplasma: ( ) yes ( ) no ( ) unknown

Viruses: ( ) yes ( ) no ( ) unknown

Other contaminants ( ) yes ( ) no ( ) unknown

Is the material pathogenic ? If so, specify:

PLEASE NOTE:

THE DSMZ ONLY ACCEPTS ORGANISMS UP TO LABORATORY CONTAINMENT LEVEL L2

CELL STORAGE CONDITIONS:

Composition of Medium:

Cell concentration:

Other recommendations:

RECOMMENDED MEDIUM AND SUBCULTIVATION PROCEDURE:

(including type and % serum, temperature, gaseous phase, optimal split ratio)

Have, until now, any additional supplements (including antibiotics) been used ?

If so, give concentrations:

I understand that this material is for deposit in the DSMZ Human and Animal Cell Lines Collection.

It will be examined, and if accepted by the DSMZ, batches will be made and distributed for a reasonable fee to cover the expences.

Signature Date

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