Submission form LABOR FÜR KLINISCHE DIAGNOSTIK GMBH & CO. KG Genetics Customer-No. / Barcode PB 1810 DE-97668 Bad Kissingen Tel +49 971 72020 Fax +49 971 68546 Business Hours: Mo - Fr: 9:00 - 18:00 h, Sa: 9:00 - 13:00 h E-Mail: [email protected]

Clinic address: Owner: Invoice to: (Stamp or block letters) (Block letters only, please) Veterinarian Name: ______Owner

First name:______

Date______of birth: ______(If the invoice should be sent to the owner or submitter, please (Owners signature for direct include their complete address and signature ) invoicing) Street: ______VAT-No.: ______Please note: Zipcode/city: Address for invoicing and ______signee must be identical Fax / e-Mail:______Fax/email: Fax/email:______Date/Signature:______Courier Tel.: ______Notification: Email Fax Mail Report copy to owner

8105 Certificate

1) The identity of the animal must be confirmed by a veterinarian (specified by Microchip-No., Tattoo-No., Pedigree-No.) 2) Certificates are not issued for partner laboratory services and genetic blood group testing of 3) Certificates are included in the services of DNA-profile and parentage testing

I have checked the animals identity and confirm that samples are taken from the animals listed below.

Name: ______Signature / Stamp veterinarian:______

Patient-ID:______Date of sampling: ______

Please note: Indication of breed is mandatory!

Animal 1 (MANDATORY - please complete using capital letters)

Sample: 0,5 ml EDTA-blood swab blood card Sex: F M

Name: ______Date of______birth:

Breed: ______Coat colour:______

Pedigree-No.:______Tattoo-No.:______

Microchip-No.:______Sample______label:

Animal 2 (MANDATORY - please complete using capital letters)

Sample: 0,5 ml EDTA-blood swab blood card Sex: F M

Name: ______Date of______birth:

Breed: ______Coat colour:______

Pedigree-No.:______Tattoo-No.:______

Microchip-No.:______Sample______label:

Animal 3 (MANDATORY - please complete using capital letters)

Sample: 0,5 ml EDTA-blood swab blood card Sex: F M

Name: ______Date of______birth:

Breed: ______Coat colour:______

Pedigree-No.:______Tattoo-No.:______

Microchip-No.:______Sample______label:

010120040010 Hereditary Diseases € 8350 Combination Hereditary Diseases Cat (HCM, HCR, GSD4, PKD, PK-Def., rdAc-PRA, SMA, genetical blood group testing)

€ 8239 8461 Alpha-Mannosidosis (AMD) Myotonia congenita (Persian) (All breeds) 8592 8349 Congenital myasthenic syndrome (CMS) Osteochondrodysplasia (, Sphynx) () 8041 8046 Gangliosidosis (GM 1/GM 2) Polycystic kidney disease (PKD) (Balinese, Javanese, , , , Seychellois, (Angora, , British Short- and Longhair, , Colourpoint, Siamese, Thai cat, Tonkinese) , Persian, , , Scottish Fold, Selkirk 8149 Rex) Gangliosidosis (GM2) (Burmese) 8395 Primary congenital glaucoma (PCG) 8113 Glycogen storage disease Type IV (GSD4) (Siamese) 8331 () Progressive retinal atrophy (b-PRA)* 8465 Head Defect* (Bengal) 8593 (Burmese) Progressive retinal atrophy (pd-PRA) 8080 Hypertrophic Cardiomyopathy (HCM1) (Angora, Birman, British Short- and Longhair, Chartreux, Colourpoint, Mutation 1 Meurs (G --> C)() Exotic Shorthair, Persian, Ragdoll, Russian Blue, Scottish Fold, Selkirk 8116 Rex) Hypertrophic Cardiomyopathy (HCM3) 8117 (Ragdoll) Progressive retinal atrophy (rdAc-PRA) 8453 Hypokalemia (Abyssinian, /Wirehair, Balinese, Bengal, Colourpoint (, Burmese, , Devon Rex, Singapura, Sphynx, Shorthair, Cornish Rex, Javanese, Munchkin, , Oriental Shorthair, Tonkinese) Peterbald, Seychellois, Siamese, Singapura, Somali, Thai, Tonkinese) 8318 8469 Hypotrichosis and short life expectancy Progressive retinal atrophy (rdy-PRA) (Birman) (Abyssinian, Ocicat, Somali) 8468 8047 MucopolysaccharidosisTyp VI (MPS6) Pyruvate kinase deficiency (PK-deficiency) (Balinese, , Javanese, Oriental Shorthair, Peterbald, (Abyssinian, Bengal, Domestic Longhair, Domestic Shorthair, Egyptian Seychellois, Siamese, Thai cat, Tonkinese) Mau, La Perm, Maine Coon, Norwegian Forest Cat, Ocicat, Savannah, 8473 Siberian, Singapura, Somali) Mucopolysaccharidosis Typ VII (MPS7) 8123 (All breeds) Spinal muscular atrophy (SMA) (Maine Coon) Coat Colours / Coat Length

8280 8281 Combination coat colours cat Combination coat colours Bengal (agouti, chocolate, cinnamon, colourpoint, dilution) (charcoal, chocolate, cinnamon, dilution, snow) 8090 8255 Coat colour variant agouti Coat colour snow (Bengal) 8242 8170 Coat colour variant albino Coat colour amber (Norwegian Forest Cat) 8442 8257 Coat colour charcoal Coat colour chocolate/cinnamon (Bengal) 8258 8147 Coat colour variant colourpoint (siam/mink/burma) Coat length (short- / long haired) (All breeds, exception Bengal) 8591 8243 Coat colour variant dominant white/white spotting Coat variant Sphynx / Devon Rex (Sphynx, Devon Rex) 8099 Coat colour dilution

If more than one colour is requested we charge 35.71 € for the first colour and 15.01 € for each additional colour.

Blood Group 8121 Genetical blood group testing, neonatal isoerythrolysis (ERYN) (all breeds except European Shorthair, Neva Masquarade, Ragdoll, Sibirian, ) Application: blood group incompatibility to determine the recessive b allele (for blood group B) 618 Serological blood group testing (only EDTA blood) (all breeds) Application: determination of serologic type A, AB or B DNA-Profiling ISAG 2006

8175 DNA Profile (genetic fingerprint) Please note: The person collecting the sample should be officially designated or appointed.

8109 Parentage verification (paternity test) each parent each offspring

A DNA profile from each parent is required for analyses of parentage. Please contact the lab prior to submission if only one parent is available for testing. 8611 Breed determination (data base analysis + DNA-profile) Please note: The test can only determine breeds found in our database. Additional information is available at www.laboklin.com or by calling us. * Partnerlab In order to allow breeding club discount for the owner please enclose a breeding club membership confirmation with each sample submission. The invoice cannot be altered subsequently.

Supply Order: Submission forms: 1 6 14 100 160 Serum tubes Swabs with transp.medium Histology containers with Allergy Hygiene 2 6a 110 150 Citrate tubes Swabs without transp.med. formalin General Farm Animal 3 6b 5 170 120 EDTA tubes Container for swabs Feacal containers Genetics Dog Pathology 3a 11 7 190 130 Heparin tubes Container for tubes Urine containers Genetics Cat Equine 4 80 1B 180 140 NaFI tubes Barcodes Eppendorf tubes Genetics Equine Reptiles 10 210 Envelopes large Birds and Small Mammals

General terms and conditions: Prices in Euro excl. VAT; Services offered and prices may be subject to change. Charge is x1.40 if invoice is sent to owner. (exception: combination tests, DNA-profiling and *partnerlab). Samples and anonymised test results can be used for scientific purpose. Please find our complete general terms and conditions of business on www.laboklin.com GB - 012004010 / 1607