Application for an Animal Remedies Merchants Licence

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Application for an Animal Remedies Merchants Licence

Licence No LM/ /

DEPARTMENT OF AGRICULTURE, FOOD AND THE MARINE

APPLICATION FOR AN ANIMAL REMEDIES MERCHANTS LICENCE

I/We, the undersigned, hereby apply to the Minister for Agriculture, Food and the Marine for a licence under Regulation 31 of the European Communities (Animal Remedies) (No. 2) Regulations, 2007 to sell animal remedies by retail, at the premises indicated beneath and I/we declare that the particulars given in this application are correct.

N.B. A separate form must be used in respect of each premises.

Status of Retail Business: Company Limited Company Partnership (Please tick as appropriate) Sole Trader Co-Operative

Veterinary Practitioner Yes □ No □ (Please tick as appropriate)

` 1. Particulars of Applicant

* (a) Name/Business Name: ______

* (b) Trading As: ______(where applicable) Address: ______(of LM premises) ______

______

(c) Telephone No: ______

Fax No: ______(if available) Email Address: ______(if available)

PPS No: ______Vat No: ______(sole trader only) (if available)

Company Registration No. ______

* (a) Applications for Companies, Co- Operatives, Partnerships must be submitted in the official name of the Business (b) A licence cannot be issued to a ‘Trading as’ entity.

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Declarations and Undertakings 2. Training of Retailers : I/We undertake to notify, in writing, the Department of Agriculture, Food and the Have youMarine or a memberof any changes of your instaff or additionsuccessfully to the completed aforementioned the FETAC/QQI particulars. approved training course, which came into effect on 1st January 2013, in accordance with Regulation 32 of the EuropeanI/We Communities declare that (Animal the premises Remedies) to which (No.2) this Regulations,application relates 2007 orconforms are you toor thea member of your conditionsstaff a Veterinary set down Nurse in the registered Schedule by 6 tothe the Veterinary European Council Communities of Ireland. (Animal (VCI) Yes □ Remedies) No □ (No. 2) Regulations, 2007, and does not constitute part of a domestic dwelling. If yes please give details of the person(s) as follows. I/We undertake to comply with the conditions, including the record-keeping requirements set out in the European Communities (Animal Remedies) (No. 2) Name ______Regulations, 2007 relating to the possession, sale or supply of animal remedies and any conditions attached to a licence granted under the said Regulations. FETAC/QQI Cert. No. / VCI Reg. No. ______I/We undertake to have in place arrangements to receive and return to the person from Course Provider ______whom he or she purchased them, an animal remedy that is unused or has reached its expiry date and in addition take steps to ensure that customers are aware of the arrangements. Name ______I/We am/are aware that a licence granted on foot of false or misleading particulars FETAC/QQI Cert. No. / VCI Reg. No. ______supplied by the applicant may be revoked.

Course I/WeProvider enclose ______licence fee €150.00 (Tick Box) (Payable to the Department of Agriculture, Food and the Marine)

NameSignature(s) ______of/on behalf of Applicant(s) ______(in the case of a company or co-operative, a FETACperson authorised /QQI Cert. for No. such / VCIpurpose Reg. on No. behalf ______of the applicant or if a partnership, all Coursepartners Provider must sign ______). ______

______Name ______

FETAC/QQINames(s) in blockCert. capitalsNo. / VCI Reg. No. ______

Course Provider ______

______Name ______Position ______FETAC/QQI Cert. No. / VCI Reg. No. ______Date ______Course Provider ______

* Please note that under Regulation 31(5)(h) an animal remedy must only be sold from the premises by a responsible person.

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(1) This form, when completed, should be returned to:

ERAD (Veterinary Medicines) Department of Agriculture, Food and the Marine Backweston Campus Young’s Cross Celbridge Co Kildare

(2) The licence fee €150 made payable to the Department of Agriculture, Food and the Marine must accompany this application.

(3) Incomplete forms or forms not accompanied by the application fee will be returned to the applicant.

(4) A licence will not be granted unless the premises conforms to the general conditions set out in the Schedule 6 to the Regulations, as detailed overleaf.

(5) It should be noted that information provided by you may be subject to disclosure under the FOI Acts 1997 and 2003. If you wish to have any of the records concerned protected under the Confidentiality, Commercially Sensitive, Personal Information or other exemption provisions of that legislation you should mark those records accordingly and state your reasons. The relevant exemptions will then be considered in the event of an FOI request relating to those records.

Office Use

Paid: ______

Date: ______

Rem: ______

3 of 5 LM/APPL Approved- Date of Issue/Revision -06/03/2017 Schedule 6 to the European Communities (Animal Remedies) (No. 2) Regulations, 2007 (S.I. No. 786 of 2007)

1. The premises shall be a permanent structure of sound construction.

2. The premises shall be capable of being adequately secured.

3. Premises contained within the curtilage of a domestic dwelling shall not be considered suitable. If a premises is attached to the dwelling, the limits of the premises to be used as a retail premises shall be clearly defined and it shall be possible to access the premises directly without trespass into the dwelling and animal remedies shall not be stored or kept for sale outside the confines of the licensed premises.

4. The premises shall preferably be a separate unit but if part of another retail facility all activities concerning the sale, supply, display and storage of animal remedies shall take place in a separate designated area.

5. The premises shall have adequate storage space to store animal remedies in the accordance with good pharmaceutical practice and in accordance with manufacturers directions.

6. Animal remedies shall be stored in a manner that will facilitate proper rotation of stock.

7. The premises shall have a designated area for the storage, prior to return or disposal, of out of date stock and damaged stock. This area shall also be used for the temporary storage of products subject to recall due to quality defect or for reasons relating to the pharmacovigilance system provided for under these regulations.

8. The premises shall have refrigerated storage and display facilities for animal remedies which require to be kept under controlled temperature conditions.

9. Storage and display facilities shall be adequate to ensure that animal remedies do not become contaminated by other animal remedies or stock on the premises or cause such contamination.

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