Annex

CERTIFICATE 1: OWNER'S PRE-EXPORT DECLARATION

Department of Agriculture and Water Resources Permit number………………………..

Identification of bird(s):

I, .............................................................., being the owner of the bird(s) described in this document, declare that:

(a)  The bird(s) has(have) been in my ownership and possession for a minimum period of one year immediately prior to the commencement of pre-export quarantine.

(b)  The bird(s) is(are) household pets and has(have) not been kept in a common aviary with other birds

(c)  The bird(s) is(are) not for commercial or recreational breeding purposes

(d)  I and my bird(s) are moving leaving New Zealand to take up residence in Australia

(e)  During the 45 days period immediately prior to export to Australia, the bird(s) has(have) been resident at the following address: ………………………………………………………………………………………….

………………………………………………………………………………………….

………………………………………………………………………………………….

(f)  During this time:

(i) the bird(s) has(have) been completely isolated from insect vectors (including mosquitoes), other birds and people who have contact with other birds.

(ii) any illness/death was reported to the New Zealand veterinary authority.

(iii) details of any medications/ treatments administered during this period are attached

Signature of Owner:............................................…….  Date:.......................................…

Name: .....................................................................……………………………………...

Address: ..............................................................………………………………………...

..................................................................………………………………………………..

I have witnessed the above signature, and after due enquiry, I have no reason to doubt the truth of this declaration.

Signature:...........................................................................Date:.........................................

Government Veterinary Officer

Name:.....................................................................……………………………………….

Address:................................................................………………………………………..

.................................................................………………………………………………...

NOTE: The certificate must bear the Official Stamp of the New Zealand Government Veterinary Officer, and must not be modified without written permission from the Department of Agriculture and Water Resources.