Animal and Plant Health Agency Customer Registration

Transcription

1 Department for Environment, Food and Rural Affairs Scottish Government Welsh Government Animal and Plant Health Agency Customer Registration Under current legislation, all sites on which livestock are kept must be registered with the Animal and Plant Health Agency (APHA). Customers are reminded of an obligation to notify APHA of any changes to the ownership, address or operation of their registered premises (farm/location/site). Please read form guidance notes (IRA57) to help you complete the form correctly and ensure all mandatory fields marked with * are completed. If you have any problems completing this form please call the Poultry Register Helpline Section 1: Customer Details This section requires details of the person or company who owns the poultry *1.1 Trading as (please tick): Individual/Hobbyist Business *1.2 Business Activity: Admin Agent Farm Manager Hobbyist Poultry Importer Agent Consultant Egg Importer Poultry Exporter Farmer Dealer Livestock Agent Poultry Company 1.3 Trading Name (if applicable): 1.4 Companies House Ref. No.: *1.5 Title (please tick): Mr Mrs Miss Ms Other *Surname: *Postal Address: *Forename: *Telephone No.: Mobile No.: address: 1.6 SB/BRN/CRN: *1.7 Please state the total number of premises (locations/sites) where you farm poultry:

2 Section 2: Premises Details Please only complete this section if you have single premises (location/site). If you have multiple premises, please complete Supplementary Section *2.1 Name and address of the premises (location/site) where poultry are kept (farm/field name): If it differs from section CPH for this Premises (location/site): Map Reference (if known): *2.4 Name and address of premises (location/site) owner (the organisation/ individual who owns the site the flocks are kept on): If it differs from section 1. *2.5 Name and address of the poultry keeper/individual responsible for the direct care of the poultry flock: If it differs from section 1. *2.6 Official Veterinary Practice details: Section 3: Poultry Details If you have one species of poultry, tick the relevant options from tables 3.1 to 3.5 below. If you hold multiple species at a location, please complete Supplementary Section 3.1.2, using information listed in the corresponding table. 3.1 Poultry Type and Stocking Numbers: Please indicate the approximate numbers of animals that are normally kept at a particular premises (location/site). Poultry Type Number Poultry Type Number Poultry Type Number Chicken Guinea Fowl Aviary Birds Turkey Pigeon Birds of Prey Duck Cassowary Psittacines + Geese Emu Rhea Pheasant Kiwi Other Birds Partridges Ostrich Quail Wild Bird + Psitticines - include cockatiels, parakeets, budgerigars, and all the birds commonly known as parrots. 3.2 Production details: Please tick appropriate production usage Breeding for egg laying Breeding for egg laying-great grandparent stock Breeding for shooting Rearing for shooting

3 Breeding for egg laying-grandparent stock Breeding for egg laying-parent stock Birds in laying flock Growing pullets up to point of lay Egg layers Breeding for meat Breeding for meat-great grandparent stock Breeding for meat-grandparent stock Breeding for meat-parent stock Breeding Poults Reared for meat Releasing for shooting Breeding for showing Reared for showing Releasing for racing Breeding for racing Reared for racing Hobby Rescue Hunting/Pest Control Display Breeding for other products (e.g. Feathers, skin) Reared for other products (e.g. Feathers, skin) 3.3 Husbandry System: Please tick relevant husbandry system Indoors Only - Floor Outdoors Only - Caged/Penned Indoors Only - Caged Outdoors Only - Penned/Paddock Outdoors Only - Released Both Indoors and Outdoors 3.4 Farm Management System: Please tick relevant farm management system Extensive Intensive Organic Free Range 3.5 Seasonal Stocking months: All Year Jan Feb Mar April May June July Aug Sept Oct Nov Dec 3.6 Are the birds within 500 metres of open body of water? Yes No 3.7 Can the birds be protected from wild bird droppings? Yes No 3.8 Do you import chickens? Yes No 3.9 If you contract grow/supply poultry for another business please state the Business name, address and contact details: Other Relevant Information Please list non-poultry livestock kept: Are you registered with APHA already? Yes No If yes please provide the CPH of premises (site) where the non-poultry animals are kept:

4 Supplementary Section Information Name and address of premises (location/site) where poultry are kept CPH for this Premises (location/site) Map Reference (if known) Name and address of premises (site) owner (the organisation/ individual who owns the site the flocks are kept on) If it differs from section 1 Name and address of the poultry keeper/individual responsible for the direct care of the poultry flock If it differs from section 1 Official Veterinary Practice Details Mobile No. Mobile No. Mobile No. Mobile No. Mobile No.

5 Supplementary Section Information Poultry Type (If you have broilers we will need to contact you for further information) Numbers Kept Production details Please state what the birds are kept for Husbandry system Farm Management System Seasonal Stocking months Please type All Year or list stocking months Are the birds within 500 metres of open body of water? Can birds be protected from wild bird droppings? Premises (location/site) name

6 4. Declaration I certify that the information given in this registration form is correct, and I undertake: That in an event of any of the contact or management details supplied in this form changing, I will inform Animal and Plant Health Agency (APHA) of such changes as soon as is practicable That in the event of indicative stock numbers changing by 10% I will inform APHA I will contact APHA to de-register if I no longer keep poultry I will provide any additional information relating to this registration as may be reasonably required by APHA. Signature Name in BLOCK LETTERS Date You can a scanned copy of the completed form and return this to PoultryRegister@apha.gsi.gov.uk but are advised that conventional is unencrypted and therefore sensitive information should not be transferred. Alternatively you can post the completed form to the APHA at the following address: Animal and Plant Health Agency (APHA) Cardiff Specialist Service Centre Government Buildings 66 Ty Glas Road Llanishen Cardiff CF14 5ZB FAIR PROCESSING NOTICE Defra, the Scottish Government, the Welsh Government and the Food Standards Agency are Data Controllers in Common in respect of personal data processed by the Animal and Plant Health Agency (APHA). For the purposes and usage of the data by APHA and the data sharing arrangements, please see the APHA Personal Information Charter on GOV.UK. A hard copy of this can be provided if required; please contact your local APHA Field Service office. APHA will not permit any unwarranted breach of confidentiality or act in contravention of their obligations under the Data Protection Act APHA is an Executive Agency of the Department for Environment, Food and Rural Affairs and also works on behalf of the Scottish Government, Welsh Government and Food Standards Agency. APHA is an Executive Agency of the Department for Environment, Food and Rural Affairs and also works on behalf of the Scottish Government, Welsh Government and Food Standards Agency to safeguard animal and plant health for the benefit of people, the environment and the economy.