DPIPWE Application Form NATIONAL LIVESTOCK …

1 department of primary Industries, Parks, Water & Environment BIOSECURITY TASMANIA NLIS Registration last updated 17 October 2017 Page 1 of 3 DPIPWE Application form NATIONAL LIVESTOCK IDENTIFICATION SYSTEM Register for: NLIS Sheep & Goats (tick applicable box) NLIS Cattle New Manager New Owner Other .. (Specify) Applicant Full Name: Trading Name: Postal Address: Town: Postcode: Phone: Fax: Mobile: Email Address: Capacity of applicant: (circle) Manager Lessee Share farmer Owner of property LIVESTOCK Owner (if same as above, write as above ) Date: Full Name: Postal Address: Town: Postcode: Email Address: Phone: Fax: Mobile: Property Owner (if same as above, write as above ) Full Name: Postal Address: Town: Postcode: Email Address: Phone: Fax.

2 Application FOR NLIS REGISTRATION NLIS Registration last updated 17 October 2017 Page 2 of 3 If property purchased within last 12 months insert previous property owner details (if known) Name: Address: Please attach proof of ownership document if property purchased within last 3 months Property Identification Code ( PIC ) of Main Property M Main Farm Address Property ID Number: (refer to council rates notice) Who is resident on main property? (name) Other blocks Property ID Number: Property ID Number: Type and Number of Animals on Property at the date of Application Please fill in appropriate box/es: Cattle Sheep Goats Alpacas Deer Dairy Beef Wool Meat Dairy Meat Pet Horses Poultry Pigs Paddock Show/ Endurance Racing Standard Racing Thoroughbred Breeder Egg Producer Breeder Grower Pet Application FOR NLIS REGISTRATION NLIS Registration last updated 17 October 2017 Page 3 of 3 DECLARATION BY PERSON IN CHARGE OF LIVESTOCK This section must be completed and signed (a) I.

3 Being the person in charge of the sheep and goats on the premises identified by the Property Identification Code (PIC) or Property Identification Number/s above, hereby apply for permission to use permanent identification devices on sheep or goats on these premises and to apply Sheep and Goats Post Breeder Tags on sheep and goats that already carry permanent identification devices. I hereby undertake to abide by the conditions of use for these devices specified under the Animal (Brands and Movement) Act 1984. (b) 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.

4 I hereby undertake to abide by the conditions of use for these devices specified under the Animal (Brands and Movement) Act 1984. Return to: Office of Registrar of Brands department of primary Industries, Parks, Water and Environment GPO Box 44 HOBART TAS 7001 Email: Ph: 1300 368 550 Fax: 6173 0308 Office Use Only Permission granted Applicant notified of general conditions : Permission refused Applicant notified: Signed: .. Date: Registrar of Brands Privacy Statement 1. Purpose of Collection The information being collected in this Application is being collected for the purposes of assessing, in accordance with Section 22A of the Animal (Brands and Movement) Act 1984, the applicant s eligibility to attach and use a permanent identification device and for the maintenance of the department s LIVESTOCK property database.

5 The information may also be used to track the movement of LIVESTOCK by inclusion on the NATIONAL LIVESTOCK Identification System (NLIS) Database. 2. Disclosure of Personal Information Personal information collected may be communicated to Meat and LIVESTOCK Australia and recorded in the NLIS Database. Personal information in the NLIS database including your name, business name and property name may be accessed by parties approved by Meat and LIVESTOCK Australia to access the NLIS Database. Your personal information may also be provided to third parties where required by law and your basic personal information may be disclosed to another public sector body if it is necessary to do so for its efficient storage or use.

6 3. Result of Failure to Provide Personal information If you do not provide any personal information requested in this Application form your Application to use a permanent identification device may not be processed. 4. Accessing Personal information A person may request access to personal information collected by the department of primary Industries, Parks, Water and Environment and may be charged a fee for this service.