Barson Distributors 2024 Ltd Animal Status Declaration 2025

Dear Client,

The information you have provided in this form will be used to complete the official MPI ASD form. This is necessary for governmental purposes and the completion of your service. By signing this document, you consent to allow Barson Distributors 2024 Ltd, to use your signature and provided information on your behalf.

You will receive a copy of your MPI form via email once your order is procesed.

Date*

Date

Declaration: I am the person in charge of these animals and I declare that I have read and understand the requirements for this ASD and that the information that follows is true and accurate.

Signature person in charge

Name person in charge*

Owner/Trade name if different from person in charge

Address animals moved from (rapid number road and town/district)*

Owners postal address if different from above

Phone*

Area CodePhone Number

Email*

example@example.com

Are any of these animals injured?*

YesNo

If "Yes" please describe injury (eg broken leg)

Destination (eg name and location of processor, saleyard or farm destination)

Stock to be removed (Under the species column, please choose the same species that is directly to the left of the column)

	Species	Quantity	Age/s	ID Tag/s
Steer
Cow
Bull
Sheep
Horse
Alpaca

Withholding periods - all animals. Are any of these animals within the withholding period of any treatment?*

YesNo

If Yes, state the product name, method of treatment, the date of the last treatment and the withholding period of the treatment (days (NB: these animals are NOT eligible for slaughter for human consumption; they are eligible for slaughter for animal consumption but must be categorised as medium risk material

Treatments

	Product Name	Method of Treatment	Date of Treatment	Withholding periods
1
2

Animal history - all animals

Were all of these animals born on your property?

YesNo

Were any of these animals imported into NZ?*

YesNo

Are any of these animals from either an MPI surveillance listed property or under MPI control for residues or any purpose other than TB?

YesNo

Animal Feeding - cattle, sheep, lambs, goats, deer, alpacas, Llamas

Have any of these animals been fed ruminant protein in their lifetime? (Ruminant protein includes meat, meat meal, bone meal, and blood meal, but excludes dairy products)

YesNo

Have any of these animals been fed ANYTHING OTHER than milk or pasture in their lifetime? (Pasture/Grass fed means that the animals have been raised under normal New Zealand farming conditions with year-round access to grass e.g. hay, silage, lucerne, feed crops or other grazed or conserved forages)

YesNo

Jone's Disease Vaccination - where applicable

Have any of these animals been vaccinated against Johne's Disease in their lifetime?

YesNo

Antimicrobial agents(s)

Have any of these animals been treated with antimicrobial agents in their lifetime for the sole purpose of promoting growth or to increase yeild?

YesNo

HGP treatment - Cattle

Have any of these animals been treated with a hormonal growth promotant in their lifetime?

YesNo

TB Declaration - cattle, deer

What is the TB Status of these animals?

Index Number

Have any of these animals been tested while under your management?

YesNo

What was the date of the last TB test for these animals?

Date

was TB detected?

YesNo

What was the date of the last TB test for the whole heard?

Date

was TB detected?

YesNo

Is the heard under TB management control? (If yes, a permit is required unless going direct to slaughter)

YesNo

Are these animals being moved from a property within a movement control area?

YesNo

If Yes, have these animals been tested within 60 days prior to this movement?

YesNoNot Applicable

I understand the obligations under the Animal Welfare Act of persons in charge of animals to ensure that their physical, health and behavioural needs are met in accordance with the minimum standards defined in Codes of Welfare under the Act 8.0 Additional information (see note 8 of the requirements)

8.0 Additional information

This box enables other important information to be given by the person completing the ASD (e.g. identifying that the animals are experimental animals, or under a farm/animal assurance programme or sheeps measles programme).

Petfood Premises Identifier