New Zealand Dairy Core Database Access Panel Application Form (Approved by the Panel pursuant to Regulation 17(a) of the Dairy Industry (Herd Testing and New Zealand Core Database) Regulations 2001) Application No: TO: The Secretary New Zealand Core Database Access Panel Or phone: fax: (07) 858 3750 (07) 858 3751 C/o David Evans DairyNZ Ltd Private Bag 3221 Hamilton 3240 FROM: The Applicant [please complete] Full name Full name or description of organisation Address Phone Fax Note: This application form is to be used to request the supply of specific data list below from the Dairy Industry Good Animal Database. See attached list for the fields and definitions of available data fields I/WE REQUEST ACCESS TO DATA FROM THE DATABASE AS FOLLOWS: [State exactly what is being requested. Use the list of data items and specify what data items are required and any parameters that are applicable. Please insert additional pages if more space is required.] Core Data Fields All core data fields are required: Y/N Only fields selected below (tick required fields from the list below): Key data 1. 2. 3. Farm location Herd number, Participant code, Static data, 4. Unique animal identifier, 5. Sire official indicator, 6. Sire, 7. Genetic dam, 8. Sex, 9. Date of birth, 10. Date of birth confidence indicator, 11. Breed, 12. Breed 16ths, Page 1 Event data, 13. Herd management number, 14. Herd management number start date, 15. Herd management number end date, 16. Date animal entered herd, 17. Date animal exits herd, 18. Animal fate, 19. Cause of fate, 20. Calving date, 21. Abnormal calving circumstances, 22. Calving assistance, 23. Calf number within parturition, 24. Fate of calf, 25. Comment code, 26. Date of mating, 27. Mating type, 28. Mating sire, 29. Embryo implant serial number, 30. Embryo implant date, 31. Embryo donor, 32. Embryo sire, 33. Embryo recipient, 34. Drying off date, 35. Drying off reason Production data, 36. Herd test date 37. Abnormal test code 38. PM milk volume 39. AM milk volume 40. Fat percentage 41. Protein percentage 42. Somatic cell count 43. Average number of milking’s 44. Pre-test milking date stamp 45. Test 1 date stamp 46. Test 2 date stamp WHEN: [Please indicate when you would like to receive this information and the reason for the timing if urgency is requested.] Please see below HOW OFTEN: [If supply of this data is required on an ongoing basis please indicate how often you require it] Daily Weekly Monthly Annually Other (specify) PURPOSE FOR WHICH THE DATA WILL BE USED: [Please describe what you intend to use the data for.] Page 2 THE SUPPLY OF THIS DATA MEETS THE PRESCRIBED CRITERIA FOR GRANTING ACCESS BY: [Criteria for granting access] (1) The Panel must grant an application for access to data in the core database only if it is satisfied that to do so is likely to be beneficial to the New Zealand dairy industry. (2) If the Panel is not satisfied that granting an application for access to data in the core database is likely to be beneficial to the New Zealand dairy industry, the Panel may grant an application for access to data in the core database only if the Panel is satisfied that to do so would not be harmful to the New Zealand dairy industry] OTHER PARTIES [List all other persons or classes of person who may have access to the data or any derivative or derived product form the data pursuant to this application] HOW THE DATA IS REQUIRED TO BE SUPPLIED: [Please tick the way you would like the information supplied] Electronic copy, computer file Electronic copy, transmission Paper copy Electronic copy by transmission (or preferred alternative as suggested by the providers) CONFIDENTIALITY: [Do you wish to waive your right of Confidentiality in respect of DairyNZ Limited as the manager of the core database] Pursuant to Regulation 25(3) I wish to waive my rights to confidentiality in respect of DairyNZ Limited, and I authorise the New Zealand Core Database Access Panel to advise DairyNZ Limited of this application and request DairyNZ Limited to assist me and the Panel in considering my request for information as set out in this application. Signed by the applicant or the applicant’s authorised signatory: The name and position / title of the person signing this waiver: You may wish to comment on any aspects of your application, or include background information about yourself and your organisation, or generally provide any other information which you consider may be relevant to the Panel in determining whether access is granted and the terms and conditions of that access. APPLICATION FEE Please enclose your cheque for $200.00 (includes GST) payable to the ‘New Zealand Core Database Access Panel’. I declare the information in the foregoing application is true and correct: Signature of applicant or authorised signatory Date Please note: The New Zealand Core Database Access Panel has authority to make a ruling on access to core data. The Panel has jurisdiction on the releas e of all data fields listed on this application form. Should you wish to also obtain data fields not listed on this form, you should approach the appropriate entity regarding obtaining additional non-core data Page 3