animal details: dog/cat (circle) - agriculture.vic.gov.au · web viewbusiness name: proprietor....
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Code of Practice for the Operation of Breeding and Rearing Businesses (2014) Animal return form
Animal details: dog/cat (circle)
Name Date of birth
Microchip number Gender
Breed Coat colour
Medical History
Last vaccination date Vaccination record attached
Yes / No
Last worming date Worming treatment/active ingredient
Last flea treatment date Flea/tick treatment brand/active ingredient
Owner return statementRecord a statement about the reason the animal is being returned (any supporting veterinary statements must be attached)
Supporting veterinary statements have been attached (tick if attached)
Current vaccination certificates attached (tick if attached) Signed microchip transfer form (tick if attached)
Owner declarationI, __________________________________________, declare the above information to be true and correct at the date given below. I declare that I am returning this animal to the breeder for the reasons stated above. I declare that the breeder has offered me appropriate compensation based on the guarantee provided to me at the time of purchase.
Name: ____________________________________________________
Signed: ____________________________________________ Date: _____________
Breeder details
Business name:
Proprietor
Domestic Animal Business Number (issued by Council)
Breeder declaration and guarantee:I, ___________________________________________________, in accordance with the requirements with the Code of Practice for the Operation of Breeding and Rearing Businesses (Revision 1) agree to take back ownership of this animal. Any compensation given to the above listed owner has been agreed by both parties as per the guarantee provided to the owner at the time of purchase.
Name: ____________________________________________________
Signed: ____________________________________________ Date: _____________