Submission form + Invoice to owner pe 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: ______Tel.: ______Date/Signature:______

Notification: Email Fax Mail Report copy to owner Courier

8105 Certificate 106,00 NOK (NOTE: Certificate is required by NKK, SKK, DKK etc., so please remember to request it, if applicable!)

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

I have checked the animal(s) identity and confirm that the submitted sample(s) are taken from the animal(s) listed below.

Name ______and Aut-No.: ______Signature / Stamp______veterinarian: ______

Chip-/Tattoo-No.:______Date of sampling:______-

Please note: Indication of breed is mandatory!

Animal 1 (MANDATORY - please complete using capital letters)

Sample: 0,5 ml EDTA-blood 2 x Cytobrush 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) t owner + Invoice to pet

Sample: 0,5 ml EDTA-blood 2 x Cytobrush 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 2 x Cytobrush Blood card Sex: F M

Name: ______Date of______birth:

Breed: ______Coat colour:______

Pedigree-No.:______Tattoo-No.:______

Microchip-No.:______Sample______label:

010110180034 Hereditary diseases NOK NOK

8166 8192 Achromatopsia (Day blindness) (ACHM-1) 500,00 Familial Nephropathy (FN) 500,00 (, Labrador ) (English Springer , Samoyed) 8259 8272 Adult Onset Neuropathy* (AON) 912,00 Fanconi Syndrome* 912,00 (English , ) (Basenji) 8313 8467 Alaskan Encephalopathy (AHE) 500,00 Finnish Ataxia (FHA) 500,00 (Husky) () 8479 8016 Polyneuropathy (AMPN) 500,00 Fucosidosis 500,00 (Alaskan Malamute) () 8303 8323 Amelogenesis Imperfecta (AI) 500,00 Gallbladder Mucoceles 500,00 (Italian ) (, Cairn , , Pomeranian, 8207 Bardet-Biedl Syndrome (BBS) 500,00 ) 8077 (Puli) Glanzmann Thrombastenia (GT) 500,00 8219 Brachyuria (Stumpy tail) 500,00 (Pyrenean Mountain Dog) 8007 (, Australian Stumpy Tail Cattle Dog, Austrian Pinscher, Globoid Cell Leukodystrophy (Krabbe disease) 500,00 Bourbonnais , , , Spaniel, (, Irish , West Highland White Terrier) , Danish/Swedish Farmdog, , 8322 Glycogen Storage Disease GSD Ia 500,00 , , , Pyrenean Shepherd, Savoy (Maltese) Sheepdog, , Spanish Waterdog, , ) 8513 Glycogen Storage Disease GSD II (Pompe disease) 500,00 8184 C3-Deficiency (C3) 500,00 (, , ) 8156 (Brittany Spaniel) Glycogen Storage Disease GSD IIIa 500,00 8012 Canine Leukocyte Adhesion Deficiency (CLAD) 500,00 (Curly Coated Retriever) 8066 (, Irish Red and White Setter) GM1-Gangliosidosis (GM1) 500,00 8330 Canine Multi-focal Retinopathy (CMR1/2/3) 651,00 (Portuguese Waterdog, , ) 8208 (American , Australian Shepherd, Boerboel, , , Coton de GM2-Gangliosidosis (Sandhoff disease) (GM2) 500,00 Tulear, Dogo Canario, Dogue de Bordeaux, English , Finnish Lapphund, (Toy ) Lapponian Herder, Pyrenean Mountain Dog, Swedish Lapphund) 8098 Grey Syndrome 500,00 8575 Canine Multiple System Degeneration (CMSD) 500,00 (Canine Cyclic Neutropenia) (Chinese Crested, ) (Collie) 8073 8232 t owner + Invoice to pet Centronuclear Myopathy (CNM) 500,00 Haemophilia A (Faktor VIII) - deficiency 651,00 (, ) (, German Shepherd, Havanese) 8314 8221 Cerebral Dysfunction (CDFS) 500,00 Haemophilia B (Faktor IX) - deficiency 651,00 () (Lhasa Apso, Rhodesian Ridgeback) 8316 8319 Chondrodysplasia (Dwarfism) 500,00 Haemorrhagic Diathesis (Scott syndrome) 500,00 (Karelian Bear Dog, ) (German Shepherd) 8326 8449 Cleft Lip/Palate and Syndactyly (CLPS) 500,00 Hereditary Ataxia (HA) 500,00 (Nova Scotia Duck Tolling Retriever) (, ) 8120 8157 Collie Eye Anomaly (CEA)* Optigen 1847,00 Hereditary Cataract (HSF4) 500,00 8304 Collie Eye Anomaly (CEA)* Partner lab 500,00 (Australian Shepherd, Wäller) 8576 (Australian Shepherd, , , , , Hereditary Cataract (HSF4)* 500,00 , Longhaired Wippet, Nova Scotia Duck Tolling Retriever, (, French Bulldog, Staffordshire ) Rough/, Shetland Sheepdog, ) 8421 Hereditary Nasal Parakeratosis (HNPK) 865,00 8256 Cone Degeneration (CD)* Optigen 1965,00 (Labrador Retriever) 8179 (Alaskan Malamute, Australian Shepherd, German Shorthaired Pointer) Hereditary Neuropathy (GHN) 500,00 8434 Congenital Hypothyroidism with Goiter (CHG) 500,00 (Greyhound) 8154 (, French Bulldog, , Spanish Waterdog, ) Hyperurikosuria (SLC) 500,00 8317 Congenital Ichthyosis 500,00 (All breeds) 8443 (Great Dane) Hypomyelination / Shaking Puppy Syndrome (SPS) 500,00 8206 Congenital Myasthenic Syndrome (CMS) 500,00 (English Springer Spaniel, ) 8481 (Jack Russell Terrier, Labrador Retriever, Old Danish , Ichthyosis* 500,00 Parson Russel Terrier) () 8011 8475 Congenital Stationary Night Blindness (CSNB) 500,00 Imerslund-Gräsbeck Syndrome (IGS) 500,00 () (, Border Collie) 8034 8198 Copper Storage Disease (Copper toxicosis) 500,00 Junctional Epidermolysis Bullosa (JEB) 500,00 () (German Shorthaired Pointer) 8348 8459 Craniomandibular Osteopathy (CMO) 651,00 Juvenile Epilepsy (JE) 500,00 (Cairn Terrier, , West Highland White Terrier) () 8013 8271 Cystinuria 500,00 Juvenile Laryngeal Paralysis & Polyneuropathy 500,00 (, Labrador Retriever, Landseer, Newfoundland, Miniature (JLPP) Pinscher) (, ) 8260 8125 Dandy-Walker-like Malformation (DWLM) 500,00 L-2-hydroxyglutaric Aciduria (L-2-HGA) 500,00 (Eurasian) (Staffordshire Bull Terrier) 8485 8270 Degenerative Myelopathy (DM) Exon 1 500,00 Lagotto Storage Disease (LSD) 500,00 (Bernese Mountain Dog) (Lagotto Romagnolo) 8158 8493 Degenerative Myelopathy (DM) Exon 2 651,00 Late Onset Ataxia (LOA) 500,00 (All breeds) (Jack Russell Terrier, Parson Russel Terrier) 8472 8487 Digital Hyperkeratosis (DH/HFH) 500,00 Polyneuropathy 1 (LPN1) 500,00 (Dogue de Bordeaux, , Kromfohrländer) (Leonberger) 8406 8327 Dry Eye Curly Coat Syndrome (CCS) 500,00 Leukocyte Adhesion Deficiency III (LAD-III) 500,00 (Cavalier ) (German Shepherd) 8484 8217 Ectodermal Dysplasia/Skin Fragility Syndrome 500,00 Macrothrombocytopenia (MTC) 500,00 (ED/SFS) (Bichon Frise, Boxer, Cairn Terrier, Cavalier King Charles Spaniel, () Chihuahua, Cocker Spaniel, Havanese, Jack Russell Terrier, Labrador 8311 Retriever, Maltese, , , Poodle, Shih

Epidermolytic Hyperkeratosis (EHK) 500,00 Tzu) 8062 (Norfolk Terrier) Malignant Hyperthermia (MH) 500,00 8202 Episodic Falling (EF) 500,00 (all breeds) 8312 (Cavalier King Charles Spaniel) May-Hegglin Anomaly (MHA) 500,00 8152 Exercise Induced Collapse (EIC) 651,00 (Pug Dog) 8032 (Boykin Spaniel, Chesapeake Bay Retriever, , Curly Coated Retriever, MDR1-gene defect* (Ivermectin hypersensibility) 500,00 Labrador Retriever, Old English Sheepdog, , Wirehaired Pointer (Australian Shepherd, Border Collie, Elo, German Shepherd, Longhaired , 8151 ) McNab, Old English Sheepdog, Rough/Smooth Collie, Shetland Sheepdog, Silken Faktor VII Deficiency 500,00 Windhound, , Wäller) (, , Beagle, Giant , ) 8131 8306 Familial Nephropathy (FN)* 651,00 Mucopolysaccharidosis Type IIIa (MPS3a) 500,00

+ Invoice to pet owner pe (English Cocker Spaniel) (Newzealand , Wirehaired Dachshound) Hereditary diseases NOK NOK

8069 8452 + Invoice to pet owner pe Mucopolysaccharidosis Type VII (MPS7) 500,00 Primary Open Angle Glaucoma (POAG) 500,00 (Brazilian Terrier, German Shepherd) (Basset Fauve de Bretagne, , Beagle, Norwegian Elkhound) 8068 8492 Muscular Dystrophy (MD) 500,00 Protein Losing Nephropathy (PLN) 500,00 (Cavalier King Charles Spaniel, Golden Retriever, Landseer, Norfolk Terrier) (Soft Coated Wheaten Terrier) 8411 8104 Musladin-Lueke Syndrome (MLS) 500,00 Pyruvate Dehydrogenase Phosphatase 1 Deficiency 500,00 (Beagle) (PDP1) 8220 Myostatin Mutation (Bully gene) 500,00 (Clumber Spaniel, ) 8015 (Whippet) Pyruvate Kinase Deficiency (PK) 500,00 8022 Myotonia Congenita 500,00 (Basenji, Beagle, Cairn Terrier, Labrador Retriever, Pug Dog, West (Australian Cattle Dog, ) Highland White Terrier) 8067 8301 Narcolepsy 500,00 Renal Cystadenocarcinoma and Nodular Fibrosis 500,00 (Dachshound, , Labrador Retriever) (RCND) 8429 Necrotizing Meningoencephalitis (NME/PDE) 500,00 (German Shepherd) 8150 (Pug Dog) Retinal Dysplasia (OSD)* Optigen 1965,00 8457 Neonatal Cortical (NCCD) 500,00 (Labrador Retriever, Samoyed) 8392 (Beagle) Retinal Dysplasia (OSD)* Partner lab 500,00 8155 Neonatal Encephalopathy with Seizures (NEWS) 500,00 (Labrador Retriever) 8328 (Standard Poodle) Severe Combined Immuno Deficiency (SCID) 500,00 8308 Neuroaxonal Dystrophy (NAD) 500,00 (Frisian , Jack Russell Terrier, Parson Russell Terrier) 8456 (Spanish Waterdog) Skeletal Dysplasia 2 (Dwarfism) (SD2) 500,00 8075 Neuronal Ceroid Lipofuscinosis (NCL) 500,00 (Labrador Retriever) 8537 (, Australian Cattle Dog, Australian Shepherd, Border Collie, Spinocerebellar Ataxia (SCA) 500,00 Chihuahua, Chinese Crested, Dachshound, , Golden Retriever, Tibetan (Fox Terrier, Jack Russell Terrier, Parson Russell Terrier, Tenterfield Terrier) Terrier) 8335 Spondylocostal Dysostosis (Comma defect) 500,00 8396 Neuronal Ceroid Lipofuscinosis (NCL)* 500,00 (Miniature Schnauzer) 8191 (American Staffordshire Terrier) Startle Disease 651,00 8215 Osteogenesis Imperfecta (Brittle bone disease) 500,00 (Irish Wolfhound) 8486 (Beagle, Golden Retriever, Shorthaired/Wirehaired Dachshound) Thrombopathia 500,00 8462 Persistent Müllerian Duct Syndrome (PMDS) 500,00 (Basset Hound, Landseer) 8143 (Miniature Schnauzer) Trapped Neutrophil Syndrome (TNS) 500,00 8017 Phosphofructokinase Deficiency (PFKD) 500,00 (Border Collie) 8302 (American Cocker Spaniel, English Springer Spaniel, , Whippet) Vitamin-D Dependent Rickets (VDR) 500,00 8142 Pituitary Dwarfism 500,00 (Pomeranian) 8119 (German Shepherd, Saalooswolfdog, Czechoslovakian Wolfdog) von-Willebrand Disease Type 1 (vWD I) 651,00 8476 Polycystic Kidney Disease (PKD) 500,00 (Bernese Mountain Dog, Coton de Tulear, Dobermann, Drentsche Patrijshond, , Kerry Blue Terrier, Labradoodle, , Papillon, (Bull Terrier) 8053 Pembroke Welsh Corgi, Poodle, Stabyhoun) Postoperative Haemorrhage (P2Y12) 500,00 _- 8014 (Great Swiss Mountain Dog) von-Willebrand Disease Type 2 (vWD II) 651,00 8141 Prekallikrein Deficiency (KLK) 500,00 (German Shorthaired Pointer, German Wirehaired Pointer) 8233 (Shih Tzu) von-Willebrand Disease Type 3 (vWD III) 651,00 8483 Primary Cilliary Dyskinesia (PCD) 500,00 (, Scottish Terrier, Shetland Sheepdog) 8347 (Old English Sheepdog) Warburg Micro Syndrome 1 (WARBM1) 500,00 8321 Primary Hyperoxaluria (PH) 500,00 (Husky) 8063 (Coton de Tulear) X-chromosomal Severe Immuno Deficiency 500,00 8226 Primary Lens Luxation (PLL) 500,00 (X-SCID) (, American Hairless Terrier, Australian Cattle Dog, Chinese (Basset, Welsh Corgi) 500,00 Crested, Danish Svedish Farmdog, Fox Terrier, Jack Russell Terrier, Jagd Terrier, 8305 , Lancashire Heeler, Lucas Terrier, X-linked Myopathy (XL-MTM) Norfolk Terrier, , Parson Russell Terrier, , Pug Dog, Rat (Labrador Retriever, Rottweiler) Terrier, , , Tenterfield Terrier, , , , , Westphalia Terrier, )

______t owner + Invoice to pet Progressive Retinal Atrophy (PRA) NOK NOK

8574 8094 Bas-PRA1 500,00 prcd-PRA* Optigen 1965,00 8127 (Basenji) prcd-PRA* Partner lab 651,00 8375 CNGA1-PRA 500,00 (American Cocker Spaniel, American Eskimo Dog, (Shetland Sheepdog) Australian Cattle Dog, Australian Shepherd, Australian Stumpy Tail Cattle Dog, 8135 Bolonka Zwetna, Chesapeake Bay Retriever, Chihuahua, Chinese Crested, crd-PRA 500,00 English Cocker Spaniel, , (Wirehaired Dachshound) Entlebucher Mountain Dog, Finnish Lapphund, German , , 8332 Golden Retriever, Karelian Beardog, Kuvasz, Labradoodle, Labrador Retriever, crd1-PRA 500,00 Lagotto Romagnolo, Lapponian Herder, Markiesje, Norwegian Elkhound, (American Staffordshire Terrier) Nova Scotia Duck Tolling Retriever, , Poodle, Schipperke, 8333 crd2-PRA 500,00 Silky Terrier, , Swedish Lapphund, Wäller, Yorkshire Terrier) 8042 (American Pitbull Terrier) rcd1-PRA 500,00 8042 Dominant PRA 500,00 (Irish Setter, Irish Red and White Setter) 8042 (Bull Mastiff, ) rcd1a-PRA 500,00 8451 Generalized PRA 500,00 (Sloughi) 8309 () rcd2-PRA 500,00

8200 GR_PRA1 500,00 (Collie) 8042 (Golden Retriever) rcd3-PRA 500,00 8520 GR_PRA2 500,00 (, Chinese Crested Dog) 8435 (Golden Retriever) rcd4-PRA 500,00 8573 pap_PRA1 500,00 (Australian Cattle Dog, English Setter, Gordon Setter, Irish Setter, Irish Red & (Papillon, Phalène) White Setter, Polish Lowland Sheepdog, Small Munsterlander, Tibetan Terrier ) 8444 Type A-PRA* Optigen 1965,00 (Miniature Schnauzer) 8445 XL-PRA* Optigen 1965,00

(Samoyed, Sibirian Husky) Test Combinations NOK

8447 Degenerative Myelopathy (DM) Exon 1 + Exon 2 1000,00 (Bernese Mountain Dog) 8344 Degenerative Myelopathy (DM) Exon 2 + MDR1-gene defect* 1059,00 (Australian Shepherd, Border Collie, Elo, German Shepherd, Longhaired Whippet, McNab, Old English Sheepdog, Rough/Smooth Collie, Shetland Sheepdog, Silken Windhound, Wäller, White Shepherd) 8407 Dry Eye Curly Coat Syndrome (CCS) + Episodic Falling (EF) 706,00 (Cavalier King Charles Spaniel) 8310 GR_PRA1 + GR_PRA2 + Ichthyosis* 1235,00 (Golden Retriever) 8277 GR_PRA1 + GR_PRA2 + prcd-PRA* (Partner lab) 1353,00 (Golden Retriever) 8499 Juvenile Epilepsy (JE) + Furnishing + Lagotto Storage Disease (LSD) 1235,00 (Lagotto Romagnolo) 8570 Late Onset Ataxia (LOA) + Spinocerebellar Ataxia (SCA) 1000,00 (Jack Russell Terrier, Parson Russell Terrier) 8571 Late Onset Ataxia (LOA) + Spinocerebellar Ataxia (SCA) + Primary Lens Luxation (PLL) 1235,00 (Jack Russell Terrier, Parson Russell Terrier)

Coat colours / Coat length 8144 8146 A-locus (alleles: Ay, Aw, at, a) 500,00 EM-locus (melanistic mask allele) 500,00

8023 8195 B-locus (brown, chocolate, liver(nose)) 500,00 Furnishing (wire hair) 500,00

8124 8599 Coat length I (long or short hair) 500,00 Hairlessness (powderpuff) 500,00 Additional gene loci have to be analysed for complete characterisation in (Chinese Crested Dog, Mexican Hairless Dog, Peruvian Hairless Dog) 8254 the following breeds: H-locus (harlequin) 500,00 Afghan Hound, Inu, Alaskan Malamute, , Eurasian, (Great Dane) Husky, Prague Rattler, Samoyed 8405 t owner + Invoice to pet Improper coat 500,00 8397 Coat length II (long or short hair) 500,00 (Portuguese Waterdog) 8145 K-locus (test for KB allele only) 500,00 8196 Curly (curled hair) 500,00 (Please note: the alleles kbr (brindle) and ky cannot be determined using this test) 8136 8188 D-locus (dilution) 500,00 M-locus (, cryptic merle) 500,00

8018 8307 E-locus (apricot, cream, lemon, red, yellow) 500,00 Saddle-tan 500,00 (Basset Hound, Welsh Corgi) 8458 8438 EG-locus (domino, grizzle) 500,00 S-locus* (piebald, white spotting) 700,00 (Afghan Hound, Saluki) 8180 EH-locus (sable) 500,00 (English Cocker Spaniel)

If more than one test is requested we charge 500,00 NOK for the first and 210,00 NOK for each additional test (except S-locus).

DNA Profile according to ISAG 2006 8107 DNA Profile (Genetic fingerprint) 494,00

Please note: The person collecting the sample should be officially designated or appointed.

8109 Parental Verification (Paternaty test) each parent 494,00 NOK each offspring 706,00

A DNA profile of each parent is necessary for parentage verification. If only one parent is available, please contact the lab prior to sample submission.

8211 8212 Breed Determination (Database analysis) 1353,00 Likelihood Calculation (Analysis of blood relationship) 1353,00

Please note: The test is only valid for certain breeds in our database. Additional information is available at www.laboklin.com or by calling us.

*Partnerlab

Note: Certificate is required by NKK, SKK, DKK etc., so please remember to request it on the front page, if applicable!

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 orders for veterinarians: Submission forms:

1 6 14 100 160 Serum tubes Swabs with transp.medium Histology containers with Allergy Hygiene 2 6a 110 150 Cltrate 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 12 1B 180 140 NaFI tubes Container for slides Eppendorf tubes Genetics Equine Reptiles 10 80 210 Envelopes large Barcodes Birds and Small Mammals General terms and conditions:

Prices in NOK ex. VAT (Invoices are VAT-free for Norway); Services offered and prices may be subject to change. Charge is x1.40 if invoice is sent to owner. (exception: combination tests, + Invoice to pet owner pe 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 N - 011018034 / 1609