Signed: Date: / / [veterinary practitioner] Part B Statement of licensee I, being the licensee of the [name of licensee] premises located at [name [address of premises] of premises] state that to the best of my knowledge and belief, the statements made by the veterinary practitioner in Part A of this Schedule are true and correct. Signed: Date: / / Regulation 108 Acts of Victoria Environment Protection Act 1970 Drugs, Poisons and Controlled Substances Act 1981 Food Act 1984 Wildlife Act 1975 Acts of the Commonwealth Agricultural and Veterinary Chemicals Act 1994 Biosecurity Act 2015 Export Control Act 1982 Acts of the State of New South Wales
Signed: [veterinary practitioner] Date: / / Part B Statement of licensee I, [name of licensee] being the licensee of the premises [name of premises] located at [address of premises] state that to the best of my knowledge and belief, the statements made by the veterinary practitioner in Part A of this Schedule are true and correct. Signed: Date: / / Regulation 108 Acts of Victoria Environment Protection Act 1970 Drugs, Poisons and Controlled Substances Act 1981 Food Act 1984 Wildlife Act 1975 Acts of the Commonwealth Agricultural and Veterinary Chemicals Act 1994 Biosecurity Act 2015 Export Control Act 1982 Acts of the State of New South Wales