(Form M-8-P-1)

RIKEN BRC JAPAN COLLECTION OF MICROORGANISMSDEPOSITION DATA SHEET (BACTERIA AND ARCHAEA)DEPOSITOR
Scientist’s name:

GivenMiddle

FamilyScientist’s title:
Organization:
Address:(Country)
TEL:
FAX:
E-mail:Data supplied on this form will be recorded in the JCM database and be cited in part in the JCM Online
Catalogue of Strains. Please fill in the items below, and affix Scientist’s signature on the last page to indicatethat the information is accurate and that you agree to make the strain available to the research community.
Items 1, 5, 7, 8, 9, 11, 12, 16, the Scientist’s signature and the date are mandatory.
1. Strain designation/number and scientific name including author(s) and year of the description:
Strain designation/numberGenus

Specific epithet

Subspecific epithet
Author(s)YearHigher taxonomic rank (family, order, etc.) if the organism is not assigned to any known genus
2. Principal synonym(s) / name change, author(s) and year of publication(s):3. History since isolation (If you did not isolate this strain, please indicate from whom you received it withthe following information, provider; institution, country; strain designation/number*):
JCM ¬ Depositor ()¬¬¬¬(*Describe the strain designation/number if another one was used in the history)

4. Other culture collection designation(s) (if deposited elsewhere):
5. Original sampling (‘access’) and isolation data (even if you did not isolate the strain, please
describe the country of origin and date of the original sampling, at least):
Original source(2021-02-08)*

(Form M-8-P-2)
Country of origin(or place/area name if the sample was collected from an area beyond national jurisdiction)
Sampling area (e.g., city, province)
Geographic coordinates (if possible)
Sampling date

(dd/mm/yyyy or mm/yyyy)

Responsible person and institute of the sampling(Person)(Institute)
Person who isolated the strain
Person who identified the strain
Reference(s) relevant to the sampling and/or isolation () (Ref. No. as in item 14)

6. Information relating to the Convention on Biological Diversity (CBD) (if applicable)
Identification number of Internationally Recognized Certificate of Compliance (IRCC) based on theNagoya Protocol
Relevant information
7. Is this the type strain?
❏ Yes ® Ref. () (Ref. No. as in item 14)❏ To be submitted for a new taxon:❏ New species❏ New subspecies❏ No ® Any description about the nomenclatural status of the strain is very much appreciated.
8. Is this strain genetically modified microorganism?
❏ Yes ® Please attach Form M-8-G for the Legally Required Information for the Living ModifiedOrganism❏ No ® Please attach publications describing this microorganism (if any).
9. Recommended medium and growth condition (Please attach a sheet of the detailed formula):MediumTemperature

˚C❏ Aerobic❏ Anaerobic

Other condition

Medium for a special purpose (e.g., sporulation etc.) or other comments, if necessary.
10. Recommended method(s) for long-term preservation:❏ Freezing❏ Freeze-drying❏ L-drying❏ Other method or comments
11. Is this strain pathogenic?
❏ Yes❏ No❏ Unknown

If yes, please specify the host organism(s).
Ref. ()(Ref. no. as in item 14)

Biosafety Level of facilities where the organism should be handled at: ❏ 1
According to: ❏❏2❏ Depositor’s recommendation

12. Accession number of 16S rRNA gene sequence:❏ Released❏ Not yet released ® Please send the data to <inquiry.jcm@riken.jp> in a text format.
(2021-02-08)*

(Form M-8-P-3)
13. Other data (taxonomy, physiology, ecology, phylogeny, application, etc.) of the strain. [Please cite thereference number(s) corresponding to item 14]:

14. References (Reprints will be appreciated):
(1)
(2)
(3)
(4)
15. Comments:

16. When do you wish the strain to be released to the public?
❏ Immediately after completion of the process for accessioning and distribution of the strain at RIKENBRC-JCM.
❏ After a paper describing the strain is published (including a paper in press appearing online). In anycase, the strain will be made accessible to the public after a lapse of five years following deposition
irrespective of the above choice.

Scientist’s signature

Please send to:
Microbe Division / Japan Collection of Microorganisms
RIKEN BioResource Research Center
3-1-1 Koyadai, Tsukuba, Ibaraki 305-0074, Japan
E-mail: inquiry.jcm@riken.jp (please attach a scanned image)
FAX: +81 29 836 9561

DateColumn to be filled by RIKEN BRC(User No.
(Reception Date
(Accession No. JCM(Date Culture Received(dd/mm/yyyy)))))(2021-02-08)*