Docstoc

Tasmania – Order Form for Leader NLIS (Cattle) Ear Tags & Matching

Document Sample
Tasmania – Order Form for Leader NLIS (Cattle) Ear Tags & Matching Powered By Docstoc
					           Tasmania – Order Form for Leader NLIS (Cattle)
                 Ear Tags & Matching Visual tags
 PROPERTY IDENTIFICATION CODE                                               ORDER NUMBER



Name of Applicant:                                                    Trading Name:

ABN:                                                                    Date:
Property Address:



Phone:                                                                 Fax:
Mobile:
Declaration by Applicant – I……………………………..….being the person in charge of the cattle on the premises identified by the property
identification code above, hereby apply for permission to attach permanent identification devices to cattle on these premises. I hereby
undertake to abide by the conditions of use for these devices specified under the Animal Act 1984. I hereby give DPIWE permission to
provide the NLIS database with details of my name, address and telephone number.


Signature: _____________________                                                         Date: __/__/__

Tag Style                                                                Quantity          Price per unit             Total Cost
                                                                         Required         (Includes GST)           (Includes GST)

White Breeder                 (Born on Property)

If you have previously ordered Leader Tags your serial
numbers will follow on from last order. If you require a
different series of numbers complete below.
Series start number:________________________

Orange Post Breeder (Brought onto
                                       property)

If you have previously ordered Leader Tags your serial                                   F4           $1.15
numbers will follow on from last order. If you require a                                 F3           $1.10
different series of numbers complete below.                                              F2           $0.90
Series start number:________________________

Applicator: Same applicator will apply management
NLIS devices.                                                                                 $38.50
(Orders for a minimum of 100 tags will in the first
instance receive a free applicator if requested)

Postage & Handling - $5.50 for Electronic tags per
order and $11.00 for Electronic and Management Tags
per order (Includes GST)
                                                                                         Total Cost:
 To be completed only by APPROVED LIVESTOCK OR RURAL MERCHANDSING AGENT

 I ………………………………………… on behalf of ………………….(name of branch & agency) accept
 responsibility for paying for these tags on behalf of the person detailed above.
 Signed: …………………………… Date:                       ………….         Order Reference Number: …………………………….
        Tasmania – Order Form for Leader NLIS (Cattle)
              Ear Tags & Matching Visual tags




(DPIWE USE ONLY)

Permission granted: ___________Applicant notified, general conditions attached: _________Date: __/__/__
Order sent to Leader Products: ___________Date: __/__/__
Permission refused: ____________________Applicant notified: ________________________ Date: __/__/__
Signed: ______________________________ (Registrar of Brands)




                                      Privacy Statement
Personal information will be collected from you for the purpose of applying for NLIS EAR
tags for permanent identification of cattle. This information will be used by DPIWE for
determining the relevant application and may be used for other purposes permitted by the
(Animal (Brands & Movement) Act 1984, Animal Health Act 1995, Animal Welfare Act 1993,
Agricultural and Veterinary Chemicals (Control Use) Act 1995). Failure to provide this
information may result in your application not being able to be processed.
Your personal information will be used for the primary purpose for which it is collected, and
may be disclosed to courts and other agencies authorised to collect it. Your basic personal
information may also be disclosed to other public sector bodies where necessary for the
efficient storage and use of the information. Personal information will be managed in
accordance with the Personal Information Protection Act 2004 and may be accessed by the
individual to whom it relates on request to DPIWE.

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:39
posted:4/19/2010
language:English
pages:2
Description: Tasmania – Order Form for Leader NLIS (Cattle) Ear Tags & Matching ...