MOVEMENT (PERMIT) APPLICATION Please complete all* sections in full and return to : *Section 6: Stop Over Quarantine: Only if relevant contact for enquiries as to the stop-over quarantine requirements – that might be pertinent for your movement application Name of Horse 1 Horse details Microchip number Passport number AHS 1 Vaccination Date Batch AHS 2 Vaccination Date 2 AHS Vaccinations Name and contact number of administrating vet Name Physical Address Permanent Holding of Duration of resident stabling 3 Origin (months) GPS coordinates Date of departure Reason for Movement 4 Movement reason Application Name Physical Address GPS Coordinates Contact name and number at 5 Holding of Destination Destination Date of arrival Estimated period of residence at Destination Stop Over Quarantine Holding Name 6 Stop-over quarantine Arrival date Intended Departure date Private Veterinarian name Contact details Health Certification – 7 Date of examination of the Private veterinarian horse for the Health Certificate Name of company/private 8 Horse Transporter transporter Name of State Veterinarian Relevant State 9 Veterinarian at origin Contact details Name Contact details Submitter (Person to 10 make permit out to) Signed by and dated
MOVEMENT (PERMIT) APPLICATION Please complete all* sections in full and return to : *Section 6: Stop Over Quarantine: Only if relevant – contact for enquiries as to the stop-over quarantine requirements that might be pertinent for your movement application 1 Horse details Name of Horse Microchip number Passport number 2 AHS Vaccinations AHS 1 Vaccination Date Batch AHS 2 Vaccination Date Name and contact number of administrating vet 3 Permanent Holding of Origin Name Physical Address Duration of resident stabling (months) GPS coordinates Date of departure 4 Movement reason Reason for Movement Application 5 Holding of Destination Name Physical Address GPS Coordinates Contact name and number at Destination Date of arrival Estimated period of residence at Destination 6 Stop-over quarantine Stop Over Quarantine Holding Name Arrival date Intended Departure date 7 Health Certification – Private veterinarian Private Veterinarian name Contact details Date of examination of the horse for the Health Certificate 8 Horse Transporter Name of company/private transporter 9 Relevant State Veterinarian at origin Name of State Veterinarian Contact details 10 Submitter (Person to make permit out to) Name Contact details Signed by and dated
Individual%20Horse%20Movement%20form.docx