equine passport application form - pet id · pdf file · 2017-04-18equine passport...
TRANSCRIPT
Equine passport application form
(Please complete in BLOCK CAPITALS – thank you)
Data Protection: Your name and address will be retained by Pet ID Equine as the Passport Issuing Organisation. From time to time
you will be sent information about products available from us, or our marketing partners, which may be of benefit or interest to you.
Please tick here if you do not wish to receive such information by: email post phone sms
Equine’s Keeper (to whom passport should be sent)
Title : Initials :
Surname :
Address :
Post Code :
Tel No :
email :
Name of Equine :
Breed (if known) :
Sire (if known) : UELN of Sire (if known) : (Unique Equine Lifetime Number from passport)
Dam (if known) : UELN of Dam (if known) : (Unique Equine Lifetime Number from passport)
Date born (if known) : / / Height : (if unknown please tick if over one year old )
Gender (Male/Female) : Colour :
Microchip Number (if appropriate) :
Freezemark or Brand (if appropriate) : Place where bred :
Equine’s Owner
Title : Initials :
Surname :
Address :
Post Code :
Tel No :
email :
I declare that the above information is, to the best of my knowledge, true & correct.If your equine is eligible for a breed society passport then we would advise you to contact the relevant breed society.
The equines breeding will NOT be verified by Pet ID Equine.
Signature of owner : ................................................................................................ Date : ............................................................
Cheques payable to Pet ID Equine – £25.00 Per passportor to pay by credit/debit card, please complete & sign below
Please debit my credit/debit card the sum of £...............................................................
Card Number : ................................................................................... Sec No : .....................
Issue Date : ................. Expiry Date : ................... Issue No (Switch only)............................
Cardholder Name : ................................................ Signature : ...........................................
Jan 2016
For office use ONLY
UELN : ........................
.....................................
.....................................
.....................................
(Please complete in BLOCK CAPITALS – thank you)
I declare that the above information is, to the best of my knowledge, true & correct.
Signature of owner :
Date :
Data Protection: Your name and address will be retained by Pet ID Equine as the Passport Issuing Organisation. From time to time
you will be sent information about products available from us, or our marketing partners, which may be of benefit or interest to you.
Please tick here if you do not wish to receive such information by: email post phone sms
Equine’s Keeper (to whom passport should be sent)
Title : Initials :
Surname :
Address :
Post Code :
Tel No :
email :
Name of Equine :
Date born (if known) : / / Height :
Gender (Male/Female) : Colour :
Microchip Number:
Place where bred :
UELN :
Equine’s Owner
Title : Initials :
Surname :
Address :
Post Code :
Tel No :
email :
If your equine is eligible for a breed society passport then we would advise you to contact the relevant breed society. The equines breeding will NOT be verified by Pet ID Equine.
Species: Horse/Pony Donkey Mule Zebra Other
Important Guidelines for Completion of Application Form and Silhouette
Both the application form and the silhouette must be completed in BLOCK CAPITALS and in ink.
Please mark on the diagram with where the microchip is implanted in the equine. Veterinary Surgeon to sign
and stamp the silhouette.
Please indicate the equine’s white markings by lightly hatching the full extent of the marking in the
appropriate place on the diagram in red ink. Please be as accurate as possible in showing the extent of the
markings. It is not sufficient simply to indicate the top edge of a white marking. Please note, in words, details of
the white markings (e.g. ‘white to mid-cannon’ or ‘white to below knee’) in the boxes provided.
If the equine has no white markings, please write ‘nil white’ or ‘no markings’. Flesh markings should be
outlined and completely shaded. Take care not to obliterate whorls.
Coloured horses. Piebald horses are those with large irregular patches of black and white and the patches
are well defined. Skewbald horses are those with large irregular patches of white and any other colour except
black. The patches are well defined. If the horse has a coat with more than two colours it should be described
as tri-coloured. Please describe the colours eg “skewbald (chestnut & white)”.
Spotted horses. Please describe the base colour and the colour(s) of the spots eg “brown with white spots”.
The equine’s whorls (changes in the direction of hair growth) should be marked on the diagram with ‘X’
where appropriate in black ink. If the equine has no other distinguishing marks, please note, in words, the position
of the whorls, (e.g. ‘whorl mid-crest’ or ‘whorl at point of stifle’) in the boxes provided.
Please indicate on the diagram any acquired marks such as scars with ‘V’ where appropriate, and describe,
in words, these marks in the boxes provided.
Important Points
The passport will be stamped replacement if the equine is over 6 months of age or after its year of birth.
An Application form and/or silhouette which has not been satisfactorily completed will be returned to the
equine’s keeper or vet and a re-submission fee of £5.00 will be payable before the application can be processed.
Our Fast Track Service offers a 24 hour service for an additional fee of £18.00 per passport.
All passports are returned by Royal Mail unless otherwise requested and the required service paid for.
Prices correct at the time of print and are subject to change.
The Pet ID Equine horse passport is a 36 page blue riveted A5 document, to government legislation. The passport
includes all registered owner’s details, equine’s details and a silhouette.
The passport is issued to identify the equine. Pet ID Equine makes no representation in respect of the legal
ownership of the equine.
Once Pet ID Equine is in receipt of the passport application you do not have the right to cancel your request
due to the uniqueness of the document. Therefore, the payment will be retained by Pet ID Equine to cover
the cost of processing and issuing your application even if you no longer require the document.
Pet ID Equine Limited has issued over 150,000 Equine Passports and is one of the largest Defra Approved Horse Passport
Issuing Offices.
Tel: 0844 8911200
Fax: 0844 8911221
Web: www.petidequine.net
Email: [email protected]
Pet ID Equine - Stable Cottage, Wheatsheaf Road, Henfield, West Sussex, BN5 9AU United Kingdom
Registration No 4238663 Registered in England & Wales Defra Approved Passport Issuing Office : 826 073
M
Section 1 - Identification
Pet ID Equine -Jan 2016
Partie B - Signalement graphique Part B - Outline Diagram
5. Code du transpondeur (si dispoible) Transponder code (where available) Système de lecture (si différent de ISO 11784)/Reading system (if not ISO 11784): Code-barres (optionnel)/Barcode (optional):
Partie A - Données d’identification Part A - Identification details
(1) (a) Espèce/Species: ..................................................
(1) (b) Sexe/Sex: ..............................................................
(2) (a) Date de naissance/ Date of birth: ........................................................
(2) (b) Pays de naisannce/Country of birth: ..................................................
(3) Signalement/Description
(3) (a) Robe/Colour: ...........................................................................................................................................................................................
(3) (b) Tête / Head: .............................................................................................................................................................................................
(3) (c) Ant. gauche / Foreleg left: ....................................................................................................................................................................
(3) (d) Ant. droite / Foreleg right: ....................................................................................................................................................................
(3) (e) Post. gauche / Hindleg left: ..................................................................................................................................................................
(3) (f) Post. droite / Hindleg right: ...................................................................................................................................................................
(3) (g) Corps / Body: ..........................................................................................................................................................................................
(3) (h) Marques / Markings :..............................................................................................................................................................................
(4) Numéro unique d’identification valable à vie (15 chiffre)/Unique Life Number: 15 digits):
(18)(15)
(16)
(17)
GaucheLeft
DroitRight
Nez Muzzle
(12) Côté droite Right side
(13) Côté gauche Left side
(14) Ligne supérieuredes yeax
Upper eye level
GaucheLeft
DroitRight
Encolure Vue inférieure
Neck Lower view
AntérieursVue postérieure
ForeRear view
PostérieursVue postérieure
HindRear view
FOR OFFICE USE ONLY
PLEASE AFFIX MICROCHIP BARCODE HERE
PLEASE LEAVE BLANK
Signature et cachet du vétérinaire ou de la personne qualifiée ou de l’autorié compétente (nom en lettres capitales)/
Signature and stamp of the vetinarian or qualified person or competent authority (name in capital letters)/
(9) Date: .....................................................................
(10) Place:..................................................................
(11) Veterinary Signature: .......................................
Veterinary Stamp: