Importer Details (Address in St Helena)

Application for a Licence to Import Dogs and Cats into St Helena

Form issued pursuant to Regulation 3 of the St Helena Animal (Diseases) VETERINARY SECTION Regulations, 2001 (as amended).

Please complete this form in BLOCK LETTERS FOR ANRD USE: Issued on: In order for ANRD to provide an import licence of this type, ______applications should be made no later than 6 working weeks before the scheduled date that Date received: the animal(s) is expected to leave the exporting ______country. Licence No: ______

Importer Details (address in St Helena)

Your Name Contact person

Full Address

Work phone Email Fax

Exporter Details (address in exporting country)

Name Contact person

Full Address

Work phone Email Fax

Agriculture and Natural Resources Division Scotland, St Paul’s, St Helena Island. Telephone: 00 (290) 24724, Facsimile: 00 (290) 24603, Email: [email protected]

Application for a Licence to Import Dogs and Cats into St Helena

Description of Animals/s

Species* Breed ** Microchip Name Age Sex*** number (yr/mth)

* Must be members of the species Canis familiaris (domestic dog) and Felis catis (domestic cat). * * Dogs of the following breeds (including crosses of these breeds) are not eligible for importation: American Pit Bull Terrier, Dogo Argentino, Japanese Tosa, and Brazilian Fila. *** Please enter M (entire male), F (entire female), MN (neutered male), FN (neutered female).

Country of Animal’s Birth Date of Importation into St Helena

Importer’s Declaration

I the undersigned hereby declare that the information provided above is accurate to the best of my knowledge, and understand that if a ‘Licence to Import’ document is issued, I must comply in full to the conditions attached to such a licence.

Signature: Name: Date:

Where to send this application when it is completed Post, e-mail, or fax Senior Veterinary Officer Fax: +00 290 24603 Agriculture and Natural Resources Division, E-mail: [email protected] Scotland St Helena Island STHL 1ZZ Notes: (1) This form contains 2 pages. Applicants should ensure that the sheets and any supporting documentation are stapled and clipped together when submitted. ANRD will not accept applications comprising incomplete forms. (2) It is important that you attempt to apply to the UK, South African or other exporting countries veterinary organisation for a Veterinary Health Certificate as early as possible for the animal(s) to be exported, as this often takes a while to process. (3) The data collected in this form will be kept in confidence. They may however be disclosed to other third parties on the Island, if such disclosure is necessary to facilitate consideration of the related application, or is in the public interest.

Agriculture and Natural Resources Division Scotland, St Paul’s, St Helena Island. Telephone: 00 (290) 24724, Facsimile: 00 (290) 24603, Email: [email protected]