Multiple Movement Travel Permit for
Secondary Host Species of Manageable
Groomed Stock Application
Stock Act 1915, sections 21C and 21E
Stock (Cattle Tick) Notice 2005, section 11
Fee : $20.10
(This includes $1.83 GST a
Commonwealth Government tax)
Privacy Statement: The information collected on this form including personal information, is required to assist the Department of Primary Industries and Fisheries ("DPI&F") to assess your application
for a Multiple Movement Travel Permit for Secondary Host Species of Manageable Groomed Stock under the Stock Act 1915.
DPI&F may disclose the information on this form and any information associated with this form to other relevant government agencies such as local or interstate law enforcement agencies (e.g
Queensland Police Service), to assist the relevant requesting agency in its administrative or regulatory function.
The information collected will only be used for the purpose for which it has been provided and may be disclosed to other areas of DPI&F in order to assist DPI&F in its regulatory functions. Unless
otherwise identified in this statement, your personal information will not be disclosed without your consent unless it is required or authorised by law.
Any personal information you provide will be treated in accordance with DPI&F·s Privacy and Security Statement located at http://www.dpi.qld.gov.au/cps/rde/xchg/dpi/hs.xsk/79 ENA HTML.htm.
Purpose: A travel permit issued under this application is for the direct movement of secondary host species of manageable, groomed stock from the
Queensland infected zone to scheduled competition events in a Queensland free or control zone and return to the place of origin.
Please Note Conditions of Travel Permit:
The following conditions must be satisfied by the approved applicant:
The stock must be inspected by the owner or the person in charge of the stock prior to commencing the movement; and
The stock will be returning to the place of origin within five (5) days. If the stock does not return to the place of origin within 5 days
(but no more than fifteen (15) days), the stock will be inspected by an inspector or approved person at a clearing facility before leaving
the infected zone.
Applicant's Details
Family name
Given name/s
Postal address
Postcode
Telephone number
(
)
Facsimile number
(
)
Will you be the person in charge of the stock at the time movements are made?
Yes
No
Please provide name and address of that person in the space provided below.
Given name/s
Family name
Postal address
Postcode
Are you also the actual owner (as defined in the Stock Act 1915) of the stock?
Yes
No
Please provide name and address of that person in the space provided below.
Family name
Given name/s
Postal address
Postcode
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Details of Stock Relating to Application
Stock (describe the stock as fully as possible e.g. colour, type, size)
Description
Quantity
If insufficient space, attach a separate list.
Place where the stock under the permit are located at the time this application is made:
Postcode
PIC
Place where the movement of stock under the permit is to start:
Postcode
PIC
If the location specified above is a holding, provide the name of the person actually in charge of the holding:
Family name
Given name/s
Place of destination where the movement of stock under the permit is going:
Postcode
[Generic destinations apply to the Multiple Movement Permits]
PIC
Description of the route by which the stock are to travel:
Person taking delivery of the stock at completion of the movement under the permit:
Family name
Given name/s
Postal address
Postcode
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Declaration
I declare that:
the particulars provided in this application and any information associated with this application are true and correct;
I have read and understood the Privacy Statement on page 1 and I consent to the use of my information on this form as set out in
the Privacy Statement;
I will fully and accurately complete and carry a waybill and the Travel Permit as required under the Stock Act 1915;
I will comply with the provisions of the Stock Act 1915, Stock Regulations 1988 and Stock (Cattle Tick) Notice 2005 and all
conditions of the travel permit (when issued, including ensuring all necessary persons (e.g. drover) are fully aware of all conditions
pertaining to the movement of stock under such travel permit);
all stock are led, tractable and receive regular grooming; and
all stock are and will remain free of cattle ticks.
Signature of applicant
Date
/
Name of witness (please print)
/
Signature of witness
Date
/
/
Warning: A person who knowingly makes a false statement or provides information that is false or misleading may be guilty of an
offence under the Stock Act 1915.
Payment Options
Please do not pay by cash.
Please tick ONE box. Note: The application fee cannot be refunded if the application is withdrawn, refused or registration is no longer required.
Cheque made payable to 'Department of Primary Industries and Fisheries· (Please attach cheque to this application.)
Credit Card (Please complete details below)
Card type (tick ONE box):
Visa
MasterCard
American Express
Name of cardholder
Card number
Card expiry date
Signature of cardholder
/
Please foward this application to:
Your local inspector OR The Chief Inspector,
Department of Primary Industries and Fisheries,
GPO Box 46,
Brisbane QLD 4001
Office Use Only
Permit number issued
Inspector·s signature
Payment for MMP*: Cheque / Credit
Receipt number
*delete as applicable
Form FDU1531
V01 04/07
Forms Management Unit
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