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: _____________