Central West Limousin Stud &
Commercial Sale 2015
Jeremy Walsh
(0414969984
jdw2830@me.com
AGENT:
Barry Nott
(02) 6373 2215
barry.nott@bigpond.com
Angus Barlow
0418 638052
angus67@bigpond.com
McDonald Lawson Pty Ltd
73 Church St Mudgee NSW 2850
Ph: 02 63721442
MUDGEE SALEYARDS – SATURDAY 12th SEPTEMBER 2015 – 1:00pm
Central West Limousin Promotion Group invites you to enter bulls and/or females in the Central West
Limousin Stud & Commercial Sale to be held at Mudgee Saleyards on Saturday 12th September 2015.
The Sale Committee along with the Agent will ensure that throughout the sale and during the organising period
the standard of livestock and administration of the event will be of the highest standard.
Our aim is to offer 30 bulls and unlimited females. If more stud cattle are required, vendors may be invited to
enter extra entries by the Committee. If the Committee requires fewer entries in total than those received, we
reserve the right to reduce numbers accordingly.
We will also be offering Junior Stud purchasers a discount of 10% for anyone that has a stud with the ALBS
purchasing any animal at the sale.
Commercial Cattle Section: At the completion of the stud section:
Entries may be submitted for commercial Limousin & Limousin infused cattle on a standalone basis.
Entries for this section will not be accepted for commercial bulls of over one month of age or female
cattle with bull calves at foot of over one month of age at the date of sale. Contact the selling agent for all
commercial entries.
Vendors who enter cattle in this sale will need to give full details of their animals and present them for
inspection by our vet one day prior to the sale. This means that all entered cattle to be vet checked are to be at
the Saleyards by 11:00am on Friday 11th September 2015. The Sale committee, with the Vet’s valuation,
retain the right to decide which animals are to be included in the auction. Their decision will be final. All cattle
failing inspection are to be moved to yards specified by the Committee at the conclusion of the inspection. All
stud cattle will need a Pesti Virus test with paperwork to be presented on inspection day.
After the inspection a sausage sizzle will be provided.
All registered animals are to be presented in stud sale condition (weights, docility and scrotal guidelines) &
pass all LAP (Limousin Assurance Program) criteria or the committee will exclude that entry.
All cattle will be assigned a dirt pen for the duration of the two days and the Auctioneering will be conducted in
the pens. Please ensure that your pens are clean on sale day (Saturday 12th September 2015) by 9:30am.
Please note there is to be NO WASHING, FEEDING or MOVING of cattle after 9:30am on sale day.
The sale committee will be arranging an advertising program alongside the agent.
Please note entries close strictly on Friday 26th June 2015. Please forward completed entry forms together
with cheques to Sale Committee C/o Barry Nott 54 Cullenbone Lane Mudgee NSW 2850 email:
barry.nott@bigpond.com All cheques to be made payable to Central West NSW Limousin Promotion
Group. Or Direct Deposit to the Account provided.
Look forward to seeing you there.
Jeremy, Barry & Angus
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CONDITIONS OF SALE
Entry fee
Bulls 15 months to 36 months of age $160
Females over 18 months $130
Females 9 - 18 months $110
Semen, embryos or flushes $55
For each 5 bulls entered get one free: For each 5 Females entered get one free
Commercial entries to be directed to McDonald Lawson
There will be no refunds for withdrawals after entry closing date. Substitutions will incur a $25
administration fee.
Entries Close Friday 26th June 2015. Send entries to The Central West Limousin Stud &
Commercial Sale email to nott@bigpond.com.au
Cheques to be made out to Central West NSW Limousin Promotion Group
No faxed entries will be accepted. NO LATE ENTRIES WILL BE ACCEPTED.
Direct Deposit Entries to:
Bank:
Commonwealth Bank Mudgee
Account Name:
Central West Limousin Promotion Group
BSB:
062 577
Account Number: 10084775
You must enter the Stud or Surname that corresponds to your entry form, then, email your
confirmation of payment to The Treasurer: neilglen@activ8.net.au
Entries will not be accepted unless the following are received: 1. Entry Fee Cheques are to be payable to Central West NSW Limousin Promotion Group;
and confirmation of Electronic payment emailed to Treasurer neilglen@activ8.net.au
Either payment method must be received by the due date. 26th June 2015.
2. A photocopy of the original Registration papers;
3. Completed Entry form with all details;
4. Completed Comments Page;
5. Signed acceptance of Conditions of Entry;
Eligibility
1.
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Registered
All cattle must be registered with the Australian Limousin Breeders Society Ltd (ALBS).
All vendors of registered cattle must be members of the Limousin Assurance Program (LAP).
All lots are to be transferrable if the purchaser requires, with the transfer fee being paid by the
vendor. Invoicing done by ALBS.
Registered bulls are to be a minimum of grade 2 (3/4).
Registered females are to be French Pure, Australian Pure or Graded provided they are
registered.
All suckling calves are to be Registered and with NLIS device prior to inspection day and
available for transfer.
2.
Number of Entries
Vendors may nominate as many entries as they wish. If the Sale Committee requires fewer entries in
total than those nominated, the Committee reserves the right to reduce numbers accordingly. In the
event of this occurring, the vendor will receive a full refund for the entry fee of any affected
nomination.
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3.
Inspections
A representative of the sale committee and selling agent may visit vendors to inspect nominated cattle
prior to sale.
All cattle must be at the saleyards by 11.00am on Friday 11th September 2015 for inspection at the
saleyard by the independent veterinarian and Committee. These inspections will include:
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Correct NLIS device to be recorded with ALBS prior to entry;
Pestivirus test paperwork submitted;
Animal is of acceptable temperament and Structural correctness;
Bulls are a minimum of 15 months old;
Bulls are a maximum of 36 months old;
Females are not broken mouthed;
Pregnancy status of females with calves at foot 6 months and older on inspection day where
No Veterinary Certificate is provided by the vendor (see below Fertility Warranty – Females).
 Cattle to be presented in a condition befitting a stud sale. The Sale Committee reserves the
right to reject any animal with poor presentation.
 Each lot is to be inspected in a pen separate from other cattle.
 Bulls weight and scrotal circumference details are as follows:
Age
15 – 18 months
18 – 21 months
21 – 24 months
Over 24 months
Weight
No min weight
Min 560kg
Min 620kg
Min 700kg
Scrotal
31cm
32cm
33cm
34cm
The sale committee reserves the right to remove any animal from the sale for the following
reasons:
 Veterinary advice that the animal is structurally unsound (this includes broken mouthed cattle).
 Unacceptable temperament displayed at anytime while the animal is at the saleyards.
 Scrotal measurement does not meet minimum requirement.
 Weight for age not reaching minimum level as indicated (bulls only).
 Missing correct NLIS device
 Presentation of animal considered to be unsatisfactory.
Vendors are required to help move cattle through the inspection process
4.
Judging/Sale Order of Cattle
On inspection day the Judge will make their selections. This is for the lots that he thinks will be best
suited for the local market best Senior & Junior Bull, Senior & Junior Female. These cattle can be sold
at the beginning of their section if the VENDOR chooses too. Senior & Junior Bulls sold first, then
Senior & Junior Females. Cattle to be sold in catalogue order with the Judge’s choice to be penned in
designated yards once vendor has been advised. The Sale Committee reserves the right to catalogue
entries as they deem necessary to produce the best result for the sale.
5.
Age
Bulls 15 months to 36 months on sale day
Females –no age restriction. Not broken mouthed
6.
Reserve- minimum price on sale day
The minimum reserve (upset) will be $2500 for Bulls, $1500 for producing age Females and $1000 for
junior females. Individual vendors have the right to set their own reserves above the minimum on sale
day with the agent.
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Any animal to be sold at Mudgee Saleyards on Sale Day after being passed in from the sale ring is
not to be sold at a lesser price than the minimum reserve that has been set prior to sale.
All sales at the sale complex on the day of the sale will be transacted through the selling agent
McDonald Lawson Pty Ltd Mudgee. If vendors do not adhere to the above conditions, the Committee
holds no responsibility for set animal or monies lost, they also have the right to reject entry of stock
for future sales.
7.
Display/Penning
Cattle are to be individually penned on sale day by 9:30am, females to be penned with their suckling
progeny only. Cattle will be penned in catalogue order.
8.
Substitutes
Substitutes may and will be accepted ($25.00 inc GST per Substitution) entirely at the discretion of
the sale committee and each case will be determined individually.
Notification must be forwarded to the Sale Committee as soon as the animal is withdrawn and no less
than one week prior to Sale date. This is to assist with the supplementary sheet administration.
Substitutes following this date will be considered on a case by case basis by the Sale Committee
The substitute animal should be of similar age and same sex. The sale committee reserves the right to
allocate a substitute Lot number. A rejected animal may not be replaced with a substitute.
9.
Responsibility
The Sale Committee is in no way responsible for the care, maintenance or control of the stock.
10.
Health Requirements
All cattle must have a certificate from a Rural Lands Protection Board or veterinarian setting out the
status of the herd for Tuberculosis, Brucellosis, and Johnes Disease. Failure to supply correctly
completed Herd Health Status at inspection will result in rejection of entries.
Cattle from Johnes Disease Control Zones must have a MAP status, be check tested or have a "Beef
Only" status. PESTIVIRUS TEST WILL NOW BE REQUIRED.
11.
Fertility Warranty
As all vendors are to be members of the Limousin Assurance Program (LAP). The following
minimum levels of assurance will apply. Individual vendors may offer additional levels of assurance.
Females:
Females over 12 months are warranted fertile to natural service within12 months of sale. The
purchaser is to have the right to a full refund of the purchase price of the female (excluding any costs
and expenses of the purchaser) on submitting a veterinary report after the expiration of 12 months to
the effect that the purchaser has been unable to get the female in calf to natural service. The
Veterinarian must state that in his opinion the female has not suffered any injury or illness and has not
been entered into an embryo transfer program since being sold to the purchaser, which could have
affected her breeding ability.
If a female catalogued as “not in calf” or “not joined” is subsequently proved to have been in calf at
the time of the sale, the Purchaser will be entitled to a full refund of the sale price on return of the
female to the vendor.
Females over 24 months of age at sale date are to be PTIC 8 weeks or more or have a calf at foot. A
female with a calf 6 months of age or older is to be PTIC on inspection day.
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Bulls:
Bulls are sold as fertile and capable of natural service. The purchaser shall have the right to a full
refund of the cost of the bull from the vendor within six (6) months of the date of the sale, if the
Purchaser can submit a Veterinary surgeon’s report that states in his opinion that the bull has not
suffered any illness or injury which could have affected his breeding ability since being taken delivery
of by the Purchaser.
Embryos, Semen, Flushes:
Any lot consisting of PTIC recipients, embryos, flushes or semen is warranted by the vendor to be as
described in the sale catalogue.
Docility:
All animals are sold as having acceptable docility as defined by scores 1, 2 and 3 of the official
scoring system used by the Australian Limousin Breeders' Society.
The purchaser is to have the right to a full refund of the purchase price of the animal (excluding any
costs and expenses of the purchaser) within 28 days of the date of the sale or a replacement animal of
similar quality and price to be supplied by the vendor subject to submitting a veterinarian's report
stating that the animal is of unacceptable docility defined as score 4 or 5 in the official scoring system
of the Australian Limousin Breeders' Society. The veterinarian must state that in his opinion the
animal has not been mistreated in a way which would have affected its behaviour since being sold to
the purchaser. The veterinary report (together with a statutory declaration by the purchaser to the
effect that the substance of the report is believed to be true and correct) must be forwarded to the
vendor within 14 days of the date being 14 days after the sale date.
12.
Transfer and Veterinary Costs
All transfer costs are to be paid by the vendor and will be invoiced by ALBS. Veterinary inspection
costs are to be paid by the vendor and will be divided equally between animals inspected.
13.
Ear Tags and NLIS requirements
The female / calf and bull tag will be mailed to the vendor after cataloguing and are to be tagged prior
to the inspection day. All cattle must comply with the NLIS regulations applicable at the time of sale.
14.
Sale Commission
6% commission will be charged on all sales of registered cattle as set by the agent and sale committee.
Of this, 5 % will go to the selling Agent, 0.25% to Mid-Western Regional Council and 0.75% will be
forwarded to the Central West NSW Limousin Promotion Group for between sale costs.
The selling Agent will offer a 2% rebate to outside agents introducing a successful purchaser of
registered cattle and settling on their behalf within 7 days of Invoice.
15.
Catalogue Advertising
You are invited to submit advertising by the closing date of entries, Vendors will be contacted if the
printers need to alter ad’s to suit catalogue printing.
Advertising spaces FULL PAGE $150, HALF PAGE $80 – prices include GST.
16.
Sale Feature in Local Newspapers
Advertising will commence 6 weeks prior to sale in Local papers, if you have any suggestions to run
ads in your local area please contact the committee. If sufficient vendors are interested in advertising,
a pre-sale feature will be placed in The Land Newspaper approximately two weeks before the sale.
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Central West Limousin Stud &
Commercial Sale 2015
Mudgee Saleyards Saturday 12th September 2015 – 1:00pm
VENDORS CONDITIONS OF ENTRY
1.
The Vendor hereby agrees that by signing an Entry Form in respect of the above sale and
sending it to the Sale Committee, the vendor will be totally bound by the terms and conditions
set out in the Conditions of Entry.
2.
All vendors must be responsible for having their cattle ready for inspections and weighing at
specified times. If a vendor or his representative is not in attendance the vendor may be
charged a handling fee.
3.
The vendor accepts that all cattle entered by the vendor for the Sale may be inspected by a
Veterinarian appointed by the Sale Committee, the Sale Committee and/or the Agent. The
Vendor accepts that the Sale Committee shall make inspection directions from time to time.
4.
The Vendor accepts that the estimated breeding values (EBV’s) and the breeding history of all
lots as recorded on the ALBS file can be made available to prospective purchasers via both the
electronic and printed catalogue.
5.
The Vendor accepts the standards and conditions with which entries must comply as issued by
the Sale Committee.
6.
The Vendor accepts that a Veterinary Surgeon or Sale Committee may reject the Vendor’s
entry if in their opinion it does not satisfy the said standards. The Vendor agrees to
immediately remove any such entry rejected by the inspectors to a holding area as directed by
the Sale Committee.
7.
No drug, hormone or tranquilliser shall be administered to any animal listed in the sale except
under the direction of a Veterinary Surgeon who shall advise the Sale Committee if in their
opinion such drug, hormone or tranquilliser is likely to have any effect upon the animal which
would have any effect on the animal’s behaviour during the sale.
8.
The Sale Committee may at any time in its absolute discretion direct a Veterinary Surgeon to
take a sample of blood, saliva or urine from any animal listed in the Sale. In addition, random
drug testing of some entries may be carried out. The presence of any drugs not declared in
writing to the Sale Committee prior to the Sale will result in the sale being declared null and
void and the Vendor liable for a full refund of the purchase price and any expenses incurred by
the purchaser in relation to transport or cartage of the animal.
9.
Losing bidders have 1st option to purchase a lot for 30 minutes post sale.
10.
The vendor agrees that the decision of the Sale Committee is final and binding.
11.
The Vendor agrees to be bound by these terms and conditions and the Vendor hereby
absolving the Inspectors and the Sale Committee from all claims, actions and demands,
damages and expenses which the Vendor may have against the Inspectors or the Sale
Committee as a consequence of any rejection.
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12.
The Vendor certifies that the information on the Entry form is correct in every respect and in
consideration of the Sale Committee accepting the Vendor’s Entry for Sale, the Vendor agrees
to accept responsibility for and to indemnify the Sale Committee against all liability that arises
from all or part of the information that is misleading or is not correct. The Vendor agrees to be
totally responsible for all claims and demands that may be made by a Purchaser resulting from
any information given by the Vendor being misleading or not correct or resulting from the
Vendor not fulfilling any obligation or warranty for which the Vendor is responsible and the
Vendor indemnifies the Sale Committee against all such claims and demands that may be
made by a purchaser against the Sale Committee.
13.
If the Vendor consists of more than one person, then these terms and conditions bind them
jointly and each of them separately.
14.
Any animal entered in the sale that is jointly owned by Vendors with separate herd prefixes,
are both required to sign the conditions of entry.
15.
Any Vendor entering registered cattle in the Central West Limousin Stud & Commercial Sale
must be a current financial member of Australian Limousin Breeders Society Ltd and a
member of the Limousin Assurance Program.
16.
All fees and charges are including GST. Including vet costs which are to be paid by the vendor.
17.
The Sale Committee is empowered to determine the vendors for the following sale.
18.
All participating vendors are expected to co-operate in all phases of the conduct of the Sale
including providing assistance to the Sale Committee when requested.
I hereby agree to the conditions of entry for the Central West Stud Limousin Sale listed above.
Signed …………………………………………………………..
Date ……………………..
Name (print) ……………………………………………………………………………………
Stud Name……………………………………………………...
Prefix ……………………..
Please return signed and completed Vendor’s Condition of Entry, Copy of Original Registration
Certificates and Entry Details to Sale Committee Barry Nott 54 Cullenbone Lane Mudgee NSW
2850 with cheques made payable to Central West NSW Limousin Promotion Group. National
Vendor Declarations, Veterinary Certificates, Herd Health Status Forms and Pestivirus test are
to be submitted on inspection day.
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CHECKLIST PRIOR TO SALE AND ON INSPECTION DAY.
Prior to sale
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Entry forms complete.
Signed acceptance of Conditions of Entry.
Enclosed photocopy of the original Registration papers.
Cheque or EFT payable to Central West NSW Limousin Promotion Group Ltd for entry fees.
 Member of the Limousin Assurance Program (LAP).
 Each vendor may email photos of their entries to be included in the catalogue at the
committee’s discretion because of limited spaces, as there will be a colour insert.
 All bulls and females and calves have been registered with ALBS.
 All cattle being offered meet NLIS regulations and have a device fitted.
 Maximum 30 words to appear in catalogue for comments on each Lot.
 Vendor is a member of the Limousin Assurance Program.
PTIC Females over two (2) years old unless with a calf at foot less than 6 months of age on
inspection day. Veterinary Certificate confirming status required on Inspection day or our vet will
inspect.
Check Minimum Weights on bulls.
Check Minimum Scrotal size on bulls.
All Lots to be presented in a condition befitting a stud sale.
On inspection day
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National Vendor Declaration has been completed and returned to the selling agent on
inspection day.
Herd Health Status has been completed and returned to the selling agent on inspection day.
Pestivirus test results
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Central West Stud Limousin &
Commercial Sale
Mudgee Saleyards Saturday 12th September 2015
Entry Form
Name of Vendor: __________________________________________________
Herd Prefix: ______________________________________________________
Address: _________________________________________________________
_________________________________
Telephone No.: _______________________
Postcode________________
Fax: ______________________
E-mail:
Entry
No.
1
Male /
Female
DOB
Animal Name
Identifier No.
NLIS Number
(incl PIC #)
2
3
4
5
6
7
8
9
10
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Each vendor may email photos of their entries to be included in the catalogue at the
committee’s discretion, because of limited spaces, as there will be a colour insert.
NLIS tag numbers must be recorded with ALBS.
Comments can be added on the next page next to appropriate entry number.
Entries close 26th June 2015.
Please indicate if you would like to advertise in the catalogue or participate in a ‘sale feature’
in the Local Newspapers.
All EBV’s will appear in the catalogue if available from ALBS.
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Comments: (30 words or less).
Or we prefer you use exel spread sheet
Entry No. 1 _________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Entry No. 2 __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Entry No. 3 __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Entry No. 4 __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Entry No. 5 __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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Comments: (30 words or less)
Entry No. 6 __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Entry No. 7 __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Entry No. 8 __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Entry No. 9 __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Entry No. 10 __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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CATTLE HERD HEALTH STATUS DECLARATION
Instruction to owners/exhibitors:
1. Complete part 1 of this form.
2. This form is not an interstate permit. However, if stock are likely to be sold or moved onwards from a show/sale part 2 should be
Completed by your local animal health official to assist authorities prepare the necessary official interstate movement certificates.
3. This form provides the basis for preparing documentation required by other states prior to entry of cattle. Further testing and disease
certification may be required for cattle entering some states.
4. There is no provision for individual animal testing for Johne’s Disease (JD) on this form.
5. This Herd Health Status form is valid for 6 months from the date of issue. The owner must notify the issuing local animal health
official of any change in herd status or other information on the form subsequent to completion of this form.
THIS FORM IS NOT ACCEPTABLE AS AN ENTRY PERMIT TO OTHER STATES.
PART 1.
OWNER /EXHIBITOR DECLARATION.
TRADING NAME………………………………………………………………………………………………………….
ADDRESS……………………………………………………………………….TELEPHONE No………………………
SALE/SHOW……………………………………………………………………DATE……………………..
Description of cattle (Attach list if necessary)
Identification
(Brands, ear tags, tattoos)
Number
Of cattle
Description of cattle
(age, sex, breed)
(A)
Tail tag no. of property cattle currently on……………………………………………
Have these cattle been run on any other property since birth? YES / NO (delete one)
If yes, complete Section (B)
(B) Name & address……………………………………………Name &
address…………………………………………………
Tail Tag No………………………………………………...Tail Tag
No……………………………………………………..
1.Owner / Manager / Exhibitor (print name)………………………………………………………………………………..
of (print address)…………………………………………………………………………………………………………
declare that with regard to Johne’s Disease: (tick the box for the clause/s, which apply).
(1)The cattle identified above originate from a Free , Protected
, Control
, Residual
, Zone for BJD.
(2) The cattle identified above originate from assessed herds under the Cattle MAP, with a status attained in the year specified
MN1/TN1
MN2/TN2
MN3
Herd Status Certificate No………………. Date of Expiry……………..
(3) The cattle identified above originate from herds that have been check tested negative (ie: CT) in the past 12 months.
Date tested……………………………..
Approved Veterinarian…………………………………………………………………
(4) The cattle identified above originate from herds that have not been assessed for Johnes Disease (i.e.: Non Assessed Status )
(5) The cattle identified above originate from Restricted (RD) or Tested Low Prevalence (TLP) herds that are under strict regulatory
control; and
- have been undertaking official, audited test and control programs for a minimum of 2 years; and
- at least 2 consecutive annual whole herd tests have been conducted with a reactor rate not exceeding 1.5% at the latest herd test; and
- the cattle to be sold, or their dams, have been tested with negative results as part of at least the last 2 annual herd tests; and
- the cattle to be sold are not officially listed as “at risk” cattle for the particular herd; and
- the cattle to be sold have not been tested negative within 3 months of the date of the sale.
Exhibitors may also need additional certification to move between Zones or between States. Check with your local veterinary authority.
The above information, including the description of the animals and property/ies of origin is complete, true and correct.
Signature……………………………………….. Date………………………..
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PART 2
OFFICIAL ENDORSEMENT
(To be completed by a Government Veterinarian/Inspector of Stock).
The property(ies) being certified in relation to the Owners Declaration has/have been allocated Tail Tag Number(s)
………………………………………………To which the following information applies.
To the best of my knowledge and belief, and based on a search of available Departmental records:
1) I have no reason to doubt the owner’s declaration in Part 1 above.
2) Under the Australian Standard Definitions & Rules for Johne’s Disease, the herd/s has/have an assigned status of
……………………………………………………………………………………………………………….*
*Herd Status for Johne’s Disease
Non –Assessed (NA): means the infection status of the herd is unknown, but the herd is not under suspicion.
Check Tested (CT):The herd has had a negative Check Test undertaken by an approved veterinarian in the past 12 months.
Tested Negative (TN) or Monitored Negative (MN): the herd has an Assessed status under the Australian Johne’s Disease Market
Assurance Program for Cattle (Cattle MAP).
3)
a.
TUBERCULOSIS : Property Status……………………..Area Status……………………….
b.
CATTLE TICK : Tick free area – Yes / No
(delete one)
If NO, list date and place of treatment (attach if necessary).
c.
EPHEMERAL FEVER : Ephemeral fever has / has not been reported on the property of origin in the last 30 days.
d.
ENZOOTIC BOVINE LEUCOSIS (EBL): The official status of the herd is ………………………………………
Inspector of Stock : Signature……………………………………………………
(Print Name)…………………………………….Located at…………………………………………………office.
Date of issue :…………………………Telephone :…………………………….Fax :………………………………
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