Primary Industry Funding Schemes Act 1998
SA Cattle Industry Fund Contributions
(This form and payment are to be forwarded to the Cattle Industry Fund, C/O Biosecurity SA – Animal Health, 33
Flemington Street Glenside SA 5065)
I …………………………………………………………………………………………….……………………….....
(Name)
of ………………………………………………………………………………………………....……………………
(Company / Trading Name / Property Name)
address ………………………………………………………………………………………………………….……
(State)
(Post Code)
hereby declare that the amount described below represents all $1.10 contributions collected by me, as a
collection agent in accordance with the provisions of the Primary Industry Funding Schemes (Cattle
Industry Fund) Regulations 2000. The payment details below are for contributions collected on the sale
of NLIS permanent identification devices for
……………………….…….
(period)
Date of Sale
PIC No
No. of NLIS
Tags Sold
Contribution
Rate
Total
$1.10
$1.10
$1.10
(More lines can be added as necessary or attach a printout of NLIS device sales by property identification code and the corresponding
contribution provided.)
Payment of $.......................... to the SA Cattle Industry Fund is by:
(Please the method of payment being used)
Cheque (payable to the Cattle Industry Fund)
Electronic Fund Transfer - BSB No. 065-266 Acc. No. 10000792
Acc. Name Department of Primary Industries & Regions Collection Account
Credit Card - Name of Cardholder
Credit Card Type - Mastercard VISA Expiry Date
Credit Card Number - _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _

/
Security No. _ _ _ (3 digit number on the back of your card)
Cardholder Signature
……………………………………………………
(Signature)
………./…………../………...
(Date)
Version 2013-10