Sch 8Certification to take donor gametes or embryos produced from donor gametes from Victoria

Schedule 8—Certification to take donor gametes or embryos produced from donor gametes from Victoria

Regulation 9E(b)

Name of person making the certification:

Certification

For the purposes of section 36(4) of the Assisted Reproductive Treatment Act 2008 (the Act), I [name of person making the certification] of [address of person making the certification] propose to take *donor gametes/*an embryo produced from donor gametes from Victoria and certify that—

 the purpose for which the *donor gametes/*embryo produced from donor gametes will be used outside Victoria is consistent with a purpose for which it could be used in Victoria; and

 the way in which the *donor gametes/*embryo produced from donor gametes will be used outside Victoria is consistent with the way in which it could be used in Victoria; and

 I have satisfied the following matters—

 I have provided the person receiving the donor gametes or embryo produced from donor gametes (the receiving party) with a copy of the donor's consent under section 16 of the Act or evidence that the donor has provided the relevant consent;

 the donor of the gametes, or each person who donated the gametes used to produce the embryo, has consented in writing to the donor's gametes or embryo produced from the donor's gametes being taken from Victoria;

 I have been given a copy of the donor's consent or the consent of each person who donated the gametes used to produce the embryo, to take the donor's gametes or the embryo from Victoria;

 I have sighted—

 the donor's passport, driver licence or any other identification document displaying the donor's photograph and signature; or

 a certified copy of the donor's passport, driver licence or any other identification document displaying the donor's photograph and signature;

 I have provided the receiving party with the following information about the donor—

(a) the donor's unique donor identifier (if any);

(b) the donor's full name;

(d) the donor's date of birth;

(f) the donor's sex;

(g) the donor's residential address;

(h) the donor's phone number;

(k) the donor's blood group;

(l) any known genetic abnormality of the donor and, if available, any results of tests undertaken in relation to that abnormality;

(m) the number of women who have given birth to children conceived using the donor's gametes or an embryo produced from the donor's gametes, including any current or former partner of the donor;