DNA TESTING NOTIFICATION FORM
To be completed by:
- veterinarian or horse passport officer
&
- data subject
-------------------------------------------------------------------------------------------------------------------------------------Declaration: taking of hair sample to verify parentage of the horse
The undersigned hereby declares that he/she has taken a hair sample from the horse(s) listed below.
Name of horse: ……………………………………………………………………………………………………………………………………
Microchip number: …..…………………………………………………………………………………………………………………………
If the horse’s dam is present at the facility, accompany the foal’s sample with a sample taken from
the dam!
Name of horse (dam): ……………………………..…………………………………………………………………………………………..
Microchip number: ………………………………………………………………………………………………………………………………
Signature of veterinarian/horse passport officer:
Date: ……………………………………………………………………………………………………………………………………………………
City/town: ……………………………………………………………………………………………………………………………………………
Signature + stamp: ……….……………………………………....…………………………………………………………………………….
Information about the currently registered owner of the horse:
KFPS membership number: R-…..…………………………………………………………………………………………………………
Initials + last name: ……………………………………………………………………………………………………………………………..
Address: …………..………………………………………………………………………………………………………………………………….
Postal code and town/city: ………………………………………………………………………………………………………………….
Country: ………………………………………………………………………………………………………………………………………………
O
The data subject declares him/herself to agree to having the Dr. van Haeringen Laboratorium
report the results of the DNA test to the KFPS.
Owner’s signature: …………..………………………………………………..……………………………………………………………….
Complete this notification form and send it, accompanied by the bag containing the hair samples, to:
KFPS, Postbus 624, 9200 AP Drachten, The Netherlands.