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: ________________