Name: Address: Transporter: __ Departure CPH: QMS Number: __


Name: Address: Transporter: __ Departure CPH: QMS Number: __...

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Name: Address: Departure CPH: Office Use

Total Number of Cattle

Movement Date/Time:

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Transporter: __ QMS Number: __ Destination CPH: 67/102/8001 Official Ear Tag Sex D.O.B Breed

Number of Passports Attached

Veterinary Medicine Withdrawals: Unless detailed below the animals above are warranted as having completed all withdrawal periods for any other veterinary medicines they have received. Treatment & Withdrawal Details (if applicable) The above animals were treated on …………..with…………………………………………….. The withdrawal period expires on ………………………I am able to confirm this by my records. I confirm that the details listed above are accurate and correct to the best of my knowledge.

Date………………..

Owner………………………………………………………………

Food Chain Declaration Is the holding under movement for bovine tuberculosis (TB) YES/NO Is the holding overleaf under movement restrictions for any other animal disease or public health reason? (EXCLUDING A 13 DAY STANDSTILL) YES/NO

Cattle on the holding overleaf are not under movement restrictions for any other animal disease or public health reasons. Withdrawal periods have been observed for all veterinary medicines and other treatments administered to the animals while on this holding and previous holdings. To the best of my knowledge the animals are not showing signs of any disease or condition that may affect the safety of meat derived from them. No analysis of samples taken from animals on the holding or other samples has shown that the animals in this consignment may have been exposed to any disease or condition that may affect the safety of meat or to substances likely to result in residues in meat. Date………………………………………………………… Signature………………………………………………….. Print…………………………………………………………