F2 0046 NLIS Sheep or Goat Shearwell Breeder Post breeder Application by dethfT

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      Department of Primary Industries



         APPLICATION FORM
        FOR SHEEP or GOAT
 NLIS (ELECTRONIC) SHEARWELL
 BREEDER & POST BREEDER TAGS
            Livestock Disease Control Act 1994




NLIS Sheep Electronic Ear Tags are ordered
  by visiting www.dpi.vic.gov.au/nlis and
           following the prompts.



 For producers who do not have access to
    the internet or a credit card, please
 complete this form and post to DPI with a
  cheque. Address details are on page 4.




                  Version: 3 May 2012 - Page 1 of 4
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                          Department of Primary Industries
                APPLICATION FORM FOR SHEEP or GOAT
                          NLIS (ELECTRONIC) SHEARWELL
                          BREEDER & POST BREEDER TAGS
                                                    Livestock Disease Control Act 1994
 NLIS tags can be ordered over the internet by visiting www.dpi.vic.gov.au/nlis
1.   Property Identification Code (PIC) (previously known as “tail tag” number):
Do you currently have a PIC for this property?                     NO           YES       If YES, please insert your PIC below –
property?
           Insert PIC here -          3
 2. Applicant details: Tags will be posted to this address.
 Name of Applicant:
 Postal Address:
 Town:                                                                                       Postcode:
 Phone:    ( )                                 Mob:                                          Fax:      ( )
 Email address (must be supplied):

 Signature:                                                                                  Date:

 3. Farm manager details: Insert details of person responsible for husbandry of sheep (NOT company name).
 Name of Manager:

 Postal Address:

 Town:                                                                                       Postcode:

 Phone:    ( )                                 Mob:                                          Fax:      ( )
 4. Property owner:
 Property owner:

 Postal Address:

 Town:                                                                                       Postcode:

 Phone:    ( )                                 Mob:                                          Fax:      ( )
 5. Property* details (Please complete this section if property details have not previously been supplied or if the details have changed):
 Shire:

 Parish:
 Rural Address:
 (Road Number, Road Name & Town)

 Council Property / Grazing Licence Number/s:
 Tags will not be issued unless the Council Property
 Number, Rate Assessment Number (as allocated by the
 shire) or Grazing Licence Number (by DSE) is provided.
(*A property may consist of more than one block of land provided the blocks are part of the one livestock enterprise within the one locality.
Each block of land must be included on the application or on an accompanying list attached to this application.)

 6. Tick the livestock type/s run on the property and enter the current number of each livestock type:
                                                                      Horses/Mules/
                          Dairy:   Beef:     Sheep:       Goats:                           Pigs:     Poultry:     Alpaca/Llama:      Deer:
                                                                        Donkeys:
  Livestock type ()
      Number of
       livestock

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All sheep and farmed goats must be identified with an NLIS (sheep) tag before being dispatched to a saleyard, abattoir,
or another property with a different PIC. Producers can either use a visually readable NLIS (sheep) tag, or an electronic
NLIS (sheep) tag. The use of electronic NLIS (sheep) tags as part of the NLIS (sheep & goats) is voluntary. Producers
who use electronic NLIS (Sheep) tags are not required to identify their sheep with a visually readable NLIS (Sheep) tag.
If sheep or goats you buy are already identified with an electronic NLIS (sheep) tag, do not attach a second electronic
NLIS (sheep) tag. In relation to electronic NLIS (Sheep) tags, there are three brands now available, which are made by
Shearwell Australia, Allflex and Leader Products. To apply for the Allflex or Leader tag please call the Department of
Primary Industries free call Livestock Identification help line on 1800 678 779 for the appropriate application form or
order online at www.dpi.vic.gov.au/nlis. Electronic NLIS (sheep) Breeder and Post-breeder tags are GST Free.

Please tick whether these electronic NLIS tags are for Sheep                             □ or Goats □
                                                                       Quantity - In       Transfer amount to Section 12 below
                                                                        Lots of 10

              Shearwell NLIS Breeder Ear Tags                                             @ $0.90 =           $ …………                 (A)

                                                                                          Sky Blue (2007)
              Tag Colour
              The Shearwell ASET tag is a one-                                            Black (2008)
              piece tag, and is available in ‘year of
                                                                                          White (2009)
              birth’ colours. Please select the colour
              you want to order.                                                          Orange (2010)
              Please note that the minimum order for
              each colour is 10 tags.                                                     Light Green (2011)

                                                                                          Purple (2012)

                                                                                          Yellow (2013)

                                                                                          Red (2014)

              Shearwell NLIS Post-breeder Ear
                                                                                          @ $0.90 =                                  (B)
              Tags (pink)                                                                                     $ …………

              Shearwell Tag Applicator                                                    @ $12.00 =                                 (C)
                                                                                                              $ …………

 7. Starting Serial Number
If you would like the serial number that is printed on your electronic tags to commence with a specific number, please
indicate in the box below. Unless specified, serial numbers will begin on Breeder Tags and continue sequentially on
Post-breeder Tags ordered.




 8. Tag Label Options
The NLIS number is printed on the inside of the tag. Please select one of the following options to be printed on the outside of tag:
    DO NOT REMOVE
    Property or Stud name. This can be up to 16 characters long.
    NLIS with Management Number. The management number is printed in large print. The management number can be up to
     four digits long. This number will be printed on each tag. The last four digits of the serial number will also be printed on this side
     of the tag (as per Section 7). Please specify your management number in the box below (up to 4 digits long).
    NLIS with Australian Genetics Number. Please specify your Australian Genetics Number, this will be printed along with your
     serial number on the outside of the tag (up to 12 digits long).




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 9. OJD Status & Tag Label
If you would like a V or T printed on the pin for the tag please tick the appropriate box below. If you leave this
section blank we will not print anything on the pin.
    V – The pin of the tag will have a ‘V in a circle printed on it. This is for tags that are to be used to identify sheep that are OJD
    vaccinated.
    T – The pin of the tag will have a ‘T’ in a circle printed on it. This is for tags used to identify terminal (crossbred) lambs from
    OJD affected flocks.
    N/A – Your sheep tags will not have anything printed on the pin to signify their OJD status.


 10. Postage & Handling

 Postage & Handling                                                                                        @ $5.00 =                 (D)


 11. Total Amount Payable (GST Free)

             A $………..…… + B $………..…… + C $………..…… + D $………..…… =                                            $ ….……………………….
                                                                                                                (Include postage charge)

CHEQUE: Please enclose a cheque made payable to “DPI” for the total amount above and post with the completed
application form to the: Tag Registrar, DPI, PO Box 2500, Bendigo Vic 3554.
CREDIT CARD: Post the completed application form with your credit card details to the Tag Registrar DPI, PO Box 2500,
Bendigo Vic 3554 OR Fax the completed application form with your credit card details to (03) 5430 4505.

                                 Visa                           MasterCard

Card Expiry date: _____ / _____       Name on card:                                                        Amount: $


Card Number:

Signature:                                                                                   Date:    _______ / _______ / _______
NLIS tags are GST Free. If you would like a receipt for these tags please attach a request to this application form.

Please submit your completed application with the correct payment to:
Mail:         TAG REGISTRAR
              DEPARTMENT OF PRIMARY INDUSTRIES
              PO BOX 2500
              BENDIGO VIC 3554                                                                              National Livestock
Fax:          (03) 5430 4505
                                                                                                          Identification System
Phone:        1800 678 779 (9am – 4.30 pm weekdays, public holidays excluded)
                   To order livestock identification tags on line visit www.dpi.vic.gov.au/nlis
   To order Livestock Production Assurance National Vendor Declarations (NVD’s) call MLA on 1800 683 111
  For more information regarding the use of Electronic NLIS (Sheep) tags please visit www.dpi.vic.gov.au/nlis




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