Form 702
Request and Authority for Seed Certification
This form is to accompany the seed lot to the Authorised Seed Processor and then accompany the official
sample to the Seed Testing Station at the Department of Agriculture and Food Western Australia, 3 Baron-Hay
Court, South Perth WA 6151. For assistance phone (08) 9368 3721.
NB: A copy of this form may be provided to the Licensee of the variety.
Please print all information
Part A: Full name, residential and postal address of person responsible for all charges
Full name:
Signature:
Residential address:
Postcode:
Postal address:
Postcode:
Telephone:
Fax:
E-mail:
For additional copy(ies) of analysis certificate(s) please tick preferred method to receive certificate
(Note – cost of additional certificates to be paid by person receiving certificate)
Full name:
Fax:
E-mail:
Post:
Part B: To be completed and signed by the Owner/Manager of the property on which the seed was
harvested.
I declare that the Variety:
Generation:
seed described on the reverse of this form was harvested from Registered Area Number:
paddock name:
and was delivered to Seed Works Cipher:
The approximate total production from the area was:
tonnes.
All equipment used to harvest, transport and store the seed was cleaned, inspected and free of
contamination prior to use.
Name:
Signature:
Date:
Part C: This part is to be completed and signed by the person in charge of the Authorised Seed
Processor.
I declare that the seed delivered to this facility and described on the reverse of this form
a) was unloaded and stored in facilities that were cleaned, inspected and free of contamination;
b) that all machinery used to clean this seed was cleaned, inspected and free of contamination prior to
grading.
Name:
Signature:
Date:
Issue No. 7 270514
Page 1 of 2
Form No. 702
Form 702
All samples will receive full testing required by the Certified Seed Schemes.
Seed Lot Details
Seedlot 1
Seedlot 2
Seedlot 3
Seed Lot Code:
Mass of each Container (kg):
Number of Containers:
Total Mass of Seed Lot (kg)
Sew in bag labels
used:
From:
To:
(Label coding and
numbers)
From:
To:
Chemical Additives:
Do labels have pre-printed
standards on the reverse?
Is a pre-purity test required?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Method of sampling
Auto
Manual
Auto
Manual
Auto
Manual
Part D: To be completed and signed by the Authorised Seed Sampler.
The above seed was sampled in accordance with the specifications of the Certified Seed Schemes.
Name:
Signature:
Date:
Free delivery instructions
Despatch samples in enclosed postal bag at any WA Post Office.
If not using the AGWEST Plant Laboratories despatch bag, address your sample to:
AGWEST Plant Laboratories
Department of Agriculture and Food
Reply Paid 83377
South Perth WA 6151
This form is available on the APL home page
agric.wa.gov.au/agwestplantlabs
Issue No. 7 270514
Page 2 of 2
Form No. 702