MPI

Farmed Mammal Supplier Declaration - Petfood
Supplier Name*
Trading Name*
Phone*

Area CodePhone Number
Physical Address*
Email Address*
example@example.com

Stock

	Species / Type	Quantity	Age & Sex	Unique ID / Tag
1.
2.
3.

Were these animals born on your property?

YesNo
Are any of these animals under MPI movement controls for residues, for any purpose other than TB?

YesNo
Are any of these animals subject to any residue suspect list?

YesNo
Are any of these animals subject to any national disease surveillance suspect list?

YesNo
Have any of these animals been imported live into New Zealand?

YesNo
Are any cattle or deer supplied confirmed reactors to a TB Test?

YesNo
Are any cattle or deer supplied from a TB herd status Infected (I) farm?

YesNo
Have any of the animal(s) supplied ever been fed meals containing ruminant proteins?

YesNo
Have any cattle, deer, lamb or goats supplied been vaccinated against Johne's disease?

YesNo
Have any cattle, deer, lamb or goats supplied been vaccinated against Johne's disease?

YesNo
Are these animals alive an generally fit and healthy at time of presentation to the primary processor?

YesNo
Is the animal "down"?

YesNo
Is the animal injured?*

YesNo
Are any of these animals within the meat withholding period for any veterinary medicine administered by your a previous owner?*
Identify the animal and describe the injury accurately*
Date and Time of Examination

DayMonthYear
Date
Hour Minutes
Petfood Premises Identifier
Date and time of death (on-farm slaughter only)

DayMonthYear
Date
Hour Minutes
Date and time of delivery

DayMonthYear
Date
Hour Minutes
Delivery Vehicle
Ante-mortem Examiner Name
Ante-mortem Examiner Signature

Clear
Declaration & Signature
Dear Client,

The information you have provided in this form will be used to complete the official MPI form. This is necessary for governmental purposes and the completion of your order service. By signing this document, you consent to allow Barson Distributors to use your signature and provided information on your behalf.

You will receive a copy of your MPI form on your email once your order is procesed.
Supplier signature*

Clear
Date

DayMonthYear
Should be Empty:

Declaration & Signature