Form Test

Application under Direction 6.3 and /or Direction 8.2 prior to the import donor gametes or embryos into Western Australia

  • DD slash MM slash YYYY

  • The Number of Each Item to be Imported:
  • Evidence of compliance with the requirements outlined in the Guidelines must be provided.
    Please attach supporting documents to accompany the application.The required documents are listed below:
  • 1. A copy of all fees incurred by the applicant in relation to obtaining the donated gametes or embryos, verified by receipts or other documentation (53Q HRT Act).
    2. Evidence of all payments made to the donor, verified by receipts or other documentation (53Q HRT Act).
    Drop files here or
    Max. file size: 128 MB.
    • 3. A copy of the written information provided to the donor.
      4. A letter from the counsellor to confirm counselling has been provided.
      5. Evidence that counselling to the donor was provided by a health professional with equivalent qualifications of a "counsellor". "Counsellor” means a person who is eligible for full membership of the Australian and New Zealand Infertility Counsellors Association (HRT Directions 2021).
      (upload files to support points 3, 4 & 5 here)
      Drop files here or
      Max. file size: 128 MB.
      • 6. A copy of the consent to donate form signed by the donor/s and the donor’s partner (if applicable).
        7. A copy of the consent to import gametes into WA signed by the donor/s and partner (if applicable).
        (upload files to support points 6 & 7 here)
        Drop files here or
        Max. file size: 128 MB.
        • 8. Evidence regarding the current number of recipient families and the potential maximum number of recipient families for the donor (including families outside WA).
          (upload files to support point 8 here)
          Drop files here or
          Max. file size: 128 MB.
          • 9. A copy of independent legal advice as per RTAC 2011 Technical Bulletin 3.
            (upload files to support point 9 here)
            Drop files here or
            Max. file size: 128 MB.

            • The application cannot be processed if any one of the above requirements can not be met.

            • 10. The Information required under schedule 2 of the Directions that will not be available.
              11. The details of any compassionate grounds to support this application.
              (upload files to support points 10 & 11 here)
              Drop files here or
              Max. file size: 128 MB.
              • 12. A detailed explanation of the exceptional circumstances for this particular case to warrant exceeding the five family limit.
                (upload files to support point 12 here)
                Drop files here or
                Max. file size: 128 MB.
                • This field is for validation purposes and should be left unchanged.