<p> WEMA Products License Application Form</p><p>A. Company overview Registered name</p><p>Telephone FAX E-mail Website Mailing address</p><p>City/Town Province/State Country</p><p>Principal place of business</p><p>CEO name and signature</p><p>TYPE OF BUSINESS: Please check as appropriate</p><p>Sole proprietorship Limited liability company</p><p>Parastatal cooperative</p><p>A company registered in the country of: </p><p>If Yes, AFSTA membership Yes No Since Membership to National Seed Association Yes ____ No ____ If yes, since ______Years in operation</p><p>Number of employees Management Staff Technical Staff Sales Staff </p><p>Annual maize volume sales Total (No. of ______20kg bags) _ Hybrids (No. of 20kg bags) Licensing experience Years In- licensing Years Out- licensing</p><p>WEMA Products License Application Form – CONFIDENTIAL 1 B. Market coverage Markets served (countries or parts of countries . . . which parts?) Distribution channels Agents Agro- dealers Direct to farmers (%age)</p><p>Training capacity (describe ability to educate agro- dealers/farmers)</p><p>C. Commercial product range</p><p>No. of maize hybrids your company has registered % annual maize sales in hybrids vs. OPV</p><p>D. Breeding and development capacity</p><p>Company testing networks (locations and institutions)</p><p>Breeding stock (%age of hybrids from own pipeline vs. licensing from others)</p><p>E. Foundation seed production capacity Annual Production Capacity Foundation seed (tons)</p><p>Seed storage capacity Total storage (MT) Cold storage (MT)</p><p>Irrigation capacity No. of Hectares %age of Production Capacity F. Certified seed production capacity Annual Production Capacity Certified seed (tons) Seed storage capacity Total storage (MT) Cold storage (MT)</p><p>Irrigation capacity No. of Hectares %age of Production Capacity</p><p>WEMA Products License Application Form – CONFIDENTIAL 2 G. Seed Quality Accreditation to ISTA, etc (include company ID.) Routine Germplasm maintenance /purity testing capability (describe equipment, processes, overall quality management program)</p><p>H. WEMA Products requested for commercialization</p><p> Name of hybrid (s) of interest ______</p><p> Designation of Parental lines ______</p><p> Interest/capability in producing Foundation seed for own use: Yes___ No___ If yes, how much (tons)? ______</p><p> Interest/capability in producing Foundation seed for others: Yes___ No___ If yes, how much (tons)? ______</p><p> Interest/capability in producing certified seed for own use: Yes___ No___ If yes, how much (tons) ______</p><p> Interest/capability in producing certified seed for others: Yes___ No___ If yes, how much (tons)? ______</p><p> Interest/capability in selling certified seed to smallholder farmers: Yes___ No___ If yes, how much (tons)? _____</p><p>Additional information to support the Application (provide any additional information that the applicant would like to submit in the support of the application)</p><p>Date ______By______</p><p>------</p><p>Submit completed application forms to:</p><p>The Chair WEMA Application Review Committee C/O AATF Deployment Unit African Agricultural Technology Foundation P.O. Box 30709-00100, Nairobi, Kenya Tel: +254 20 422 3746/3742: Fax: + 254 20 422 3701 Email: [email protected]</p><p>WEMA Products License Application Form – CONFIDENTIAL 3 Confidentiality Statement</p><p>This document contains proprietary and confidential information. All data submitted to the WEMA Application Review Committee (ARC) is provided in reliance upon its consent not to use or disclose any information contained herein except in the context of its business dealings with your company. In the event the confidential information must be disclosed pursuant to judicial order or requirement of law, the Party to whom such order is directed shall immediately notify the other Party of such order or requirement and shall take all reasonable steps to limit such disclosure, and vice versa.</p><p>The WEMA ARC shall not disclose or communicate confidential information except to their employees who have a need to know the confidential information and any third party mutually authorised by the Parties, in writing, to receive the confidential information.</p><p>The WEMA ARC also agrees not to duplicate or distribute or permit others to duplicate or distribute any material contained herein without your company’s express written consent.</p><p>Your company retains all title, ownership and intellectual property rights to the materials and trademarks pertaining to it, contained herein, including all supporting documentation.</p><p>Each Party’s obligations of confidentiality described in this Agreement shall be binding throughout the duration of this engagement and for a period of five years following the expiration or termination of this Agreement.</p><p>NOTE:</p><p>Please note that once a seed company has been selected by the WEMA ARC to receive either WEMA hybrids or inbred lines, it need not complete the entire application form for subsequent products of interest. From the date qualification is granted, the provided data remains valid for three years and will be used in subsequent applications reviews as long as the company re-submits section H of the application form to request consideration for product available. The seed company also needs to confirm that the previous information is still valid.</p><p>WEMA Products License Application Form – CONFIDENTIAL 4</p>
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