Nz Sourced Forage And Novelty Feed Declaration

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NZ Sourced Forage and Novelty Feed Declaration
This form outlines the minimum information requirement for the transfer of locally grown and novelty feeds. Refer to the reverse of this
form for definitions and guidance on use.
Vendor (feed supplier) details:
Buyer details:
Name
Name
Supply #
Supply #
(if applicable)
Address
Address
Ph:
Email:
Ph:
Email:
Feed supply details
Delivery date(s)
(single date or date range)
Feed type:
Source
Quantity
(hay, silage, apple pomace, biscuits, etc.)
(paddock, block, processing plant, etc.)
Unit
(bales, bins, tonnes,
kgs, etc.)
Number
Carrier Details
Intended use
(clean and suitable transport provided)
(lactating animals, dry stock, calves, etc.)
Vendor declaration
I/We declare that this consignment at the time of delivery is a suitable feed to the stock class indicated above:
1. Does not contain ruminant protein or animal tissue.
2. Was not grown on, or harvested from, land:
treated or irrigated with meat waste, unless under an approved management plan compliant with the
requirements of Bio-security (Ruminant Protein) Regulations.
(Enter name of company:________________________________________);
irrigated or treated with human wastewater;
treated with sewage sludge derived from the treatment of human waste (bio-solids); or
treated or irrigated with industrial waste of any type, including petroleum industry Land farming unless
written approval for that use has been provided by the Dairy Processor receiving milk.
3. Has the feed or land on which the feed was grown been treated with any
fumigants/pesticide/insecticide/herbicide: No
Yes
3a If Yes, the chemicals have been used:
in accordance with the registered labels
Yes
No
at rates not exceeding the maximum rates set out on the label
Yes
No
the appropriate with holding periods for those chemicals has been observed
Yes
No
If any answer in section 3a is No, list these chemicals below, enter any additional information overleaf or attach
details. NOTE: this feed is not suitable for lactating animals unless approved by Dairy company receiving milk
Application
Application rate
date
Withholding period
Harvest date
Application
Application rate
date
Withholding period
Harvest date
Vendor Signature
Date
PTO

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