Code of Practice
for the Operation of Breeding
and Rearing Businesses
(2014)
Animal return form
Animal details: dog / cat
(circle)
Name
Date of birth
Microchip number
Gender
Breed
Coat colour
Medical history
Last vaccination date
Vaccination record
attached
Last worming date
Worming
treatment/active
ingredient
Last flea treatment
date
Flea/tick treatment
brand/active ingredient
Yes / No
Animal return form
July 2015 version
Page 2 of 3
Owner return statement
Record a statement about the reason the animal is being returned (any supporting veterinary statements
must be attached)

Supporting veterinary statements have been attached (tick if attached)

Current vaccination certificates attached (tick if attached)

Signed microchip transfer form (tick if attached)
Owner declaration
I, __________________________________________, declare the above information to be true and
correct at the date given below. I declare that I am returning this animal to the breeder for the reasons
stated above. I declare that the breeder has offered me appropriate compensation based on the
guarantee provided to me at the time of purchase.
Name: ____________________________________________________
Signed: ____________________________________________
Date: ________________
Animal return form
July 2015 version
Page 3 of 3
Breeder details
Business name:
Proprietor
Domestic Animal Business
Number (issued by Council)
Breeder declaration and guarantee:
I, ___________________________________________________, in accordance with the requirements
with the Code of Practice for the Operation of Breeding and Rearing Businesses (2014) agree to take
back ownership of this animal. Any compensation given to the above listed owner has been agreed by
both parties as per the guarantee provided to the owner at the time of purchase.
Name: ____________________________________________________
Signed: ____________________________________________
Date: ________________