THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION MUSEUM
FOR INTERNAL USE ONLY
Template No.: T-TK014
Template Title: Custodianship Declaration Form (Donation After Dispute Creates New Claims)
Related Research Case IDs / Cluster: TK-014 / Cluster F (Conflicts, Custody Claims) + Cluster D (Donations, Lay Faith)
Linked Templates / Policies: Donation & Acceptance Policy; Chain-of-Custody Form Set; T-TK006 Publication Approval Workflow; T-TK008 Authority-Name Use Policy; T-TK004 External-Claim Verification SOP; Data Protection & Confidentiality Policy; No-Gift Policy; Incident Reporting Form
Date of form: ____ / ____ / ______
Prepared by / Role: _______________________
Office / Unit: ____________________________
Country / Location: _______________________
Confidentiality Level:
Internal only [ ] Restricted [ ] Sacred-Restricted / Sensitive [ ]
Use of this form (tick):
New case / action [ ] Follow-up [ ] Annual review [ ] Archive only [ ]
1) Purpose
This form is used when a relic or sacred object is donated after a dispute, or when a donation may create new ownership or custody claims.
Main rule: Donation does not mean personal ownership. HSWAGATA holds items in trust for peace and protection.
2) Donation record
Donation date/time: ____ / ____ / ______ _______ (time)
Received at (location): ____________________________________
Received by (staff): _______________________________________
Second staff witness (required): ____________________________
Donation type (tick one):
Permanent donation to HSWAGATA [ ]
Temporary deposit / safekeeping [ ]
Loan for display [ ]
Transfer for testing only [ ]
Other: ____________________________________ [ ]
3) Donor / transfer person details
Full name: ________________________________________________
Photo ID checked with T-TK001? Yes [ ] No [ ]
ID type/number (last 4 digits only if needed): _______________
Phone/email: ______________________________________________
Address (optional): ________________________________________
Relationship to the item (tick):
Owner (claims) [ ] Custodian (claims) [ ] Inherited holder [ ] Monk/nun [ ] Agent/representative [ ] Finder [ ] Other: ______
If representative/agent: written authority letter attached? Yes [ ] No [ ]
4) Item details
Item name used: ___________________________________________
Item type: Tooth relic [ ] Relic fragment [ ] Relic container [ ] Other: ____
HSWAGATA Item ID (if assigned): ____________________________
Description (simple): material/size/marks/container
Photos taken for condition record (follow sacred rules): Yes [ ] No [ ]
Condition at receipt (tick): Good [ ] Fair [ ] Poor [ ] Unknown [ ]
5) Provenance and custody path (short history)
Known history (dates/places/people). If unknown, write “unknown”.
Previous locations (if known): ______________________________
Previous custodians (if known): _____________________________
Any documents provided (tick):
Donation letter [ ] Receipt [ ] Witness letter [ ] Photos [ ] Lab report [ ] “Official” letter [ ] Other: _______
If “official letter” or lab claim is included, start T-TK004/TK003: Yes [ ] No [ ]
6) Dispute disclosure (very important)
Donor/transfer person must answer:
A) Has there been any dispute about this item? Yes [ ] No [ ] Not sure [ ]
If yes, describe briefly (no blame words):
B) Is there any other person/group who may claim this item? Yes [ ] No [ ] Not sure [ ]
If yes, list names (if safe): _______________________________
C) Is there any police/government/university case linked to this item? Yes [ ] No [ ] Not sure [ ]
If yes, details: ___________________________________________
If dispute risk is High/Critical, open Incident Report: Yes [ ] No [ ]
7) Custodianship declaration (must be read and signed)
7.1 Declaration by donor/transfer person
I, _____________________________, declare that:
I am donating/transferring this item under the type selected in Section 2. [ ]
To my knowledge, I have the right to donate/transfer it. [ ]
I understand HSWAGATA will hold it as a custodian in trust, not as a personal property of any staff member. [ ]
I will not later claim private ownership rights over HSWAGATA due to this donation/transfer. [ ]
I did not give any bribe/gift to any staff for this donation/transfer. [ ]
I shared all known dispute facts honestly (Section 6). [ ]
Signature (donor/transfer): __________________ Date: ____ / ____ / ______
If donor/transfer refuses to sign:
Refused [ ] Reason (if given): ______________________________
Two staff witnesses sign that the form was read and offered:
Witness 1: __________________ Signature: __________ Date: //______
Witness 2: __________________ Signature: __________ Date: //______
8) HSWAGATA acceptance statement (internal)
HSWAGATA accepts this item under the type in Section 2 and will:
protect it with security and careful storage,
record it in inventory,
follow peaceful and ethical management,
not publish claims of authenticity without verification and approval.
Accepted by (name/role): _____________________ Signature: __________
Date: ____ / ____ / ______
Board approval required? Yes [ ] No [ ]
If yes: Board delegate name/signature: _______________________ Date: //______
9) Public communication and name use consent
May HSWAGATA mention the donor name publicly?
Yes [ ] No [ ] Limited (how): _______________________________
Any publication must follow T-TK006. Confirmed [ ]
10) Chain-of-custody attachment (mandatory)
Chain-of-custody form attached: Yes [ ] No [ ]
Temporary seal number (if used): ____________________________
Storage location assigned (restricted): ______________________
11) Attachments list (tick and label)
Donation paper/letter [ ] File name: _________________________
ID verification record (T-TK001) [ ] File name: ______________
Photos/condition record [ ] File name: ______________________
Witness letters [ ] File name: ______________________________
Other: __________________ [ ] File name: ____________________
12) Filing and review
Filed by: _______________________ Date: ____ / ____ / ______
Reviewed by (Head/Security/Board delegate): ________________ Date: ____ / ____ / ______
