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+ Invoice to owner Invoic

Submission form Customer-No. / Barcode LABOR FÜR KLINISCHE DIAGNOSTIK GMBH & CO. KG PB 1810 DE-97668 Bad Kissingen Tel +49 971 72020 Fax +49 971 68546 Business Hours: Mon - Fri: 9:00 - 18:00 h, Sat: 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/email: ______Fax/email:______Date/Signature:______Courier Tel.: ______Notification: Email Fax Mail Report copy to owner

8105 Certificate 9.00 €

1) The sample has to be collected by a veterinarian or an impartial person. 2) The identity of the animal must be specified by Microchip-No., Tattoo-No. and/or Pedigree-No. 3) Certificates are included in the services of DNA-profile and parentage testing; No certificates are provided for partnerlaboratory services.

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

Name ______veterinarian: ______Signature / Stamp______veterinarian: ______

Patient-ID:______Date of sampling:______

Please note: Indication of breed is mandatory! (Please complete using capital letters)

Animal 1 (previous result-number, if known: ______- __ - ______)

Sample: 0.5 - 1 ml EDTA-blood 2x buccal swab blood card Sex: female male

Name: ______Date of______birth:

Breed: ______Coat colour:______

Pedigree-No.:______Tattoo-No.:______

Microchip-No.: Sample______label: e to owner + Invoice

Animal 2 (previous result-number, if known: ______- __ - ______)

Sample: 0.5 - 1 ml EDTA-blood 2x buccal swab blood card Sex: female male

Name: ______Date of______birth:

Breed: ______Coat colour:______

Pedigree-No.:______Tattoo-No.:______

Microchip-No.: Sample______label:

Animal 3 (previous result-number, if known: ______- __ - ______)

Sample: 0.5 - 1 ml EDTA-blood 2x buccal swab blood card Sex: female male

Name: ______Date of______birth:

Breed: ______Coat colour:______

Pedigree-No.:______Tattoo-No.:______

Microchip-No.: Sample______label:

010110110060 Hereditary diseases € € 8552 8202 Acatalasemia 59.50 Episodic falling (EF) 59.50 (Beagle) (Cavalier King Charles ) 8166 8152 Achromatopsia (day blindness) (ACHM) 59.50 Exercise induced collapse (EIC) 77.50 (, Labrador ) (, , , Curly Coated 8595 59.50 Retriever, , , , Acute respiratory distress syndrome (ARDS) Wirehaired ) () 8259 8151 Adult onset neuropathy * ̓ ** (AON) 77.50 Faktor VII deficiency 59.50 (English , ) (Airedale , , Beagle, Finnish , Giant , 8313 Alaskan encephalopathy (AHE) 59.50 Scottish Deerhound, ) 8131 (Husky) Familial nephropathy (FN)* 77.50 8479 polyneuropathy (AMPN) 59.50 (, Welsh Springer Spaniel) 8192 (Alaskan Malamute) Familial nephropathy (FN) 59.50 8601 Alexander disease (AxD) 59.50 (, Samoyed) 8272 (Labrador Retriever) Fanconi syndrome 59.50 8303 Amelogenesis imperfecta (AI) 59.50 (Basenji) 8467 (Italian Greyhound) ataxia (FHA) 59.50 8207 Bardet-Biedl syndrome (BBS) 59.50 (Finnish Hound, Norrbottenspitz) 8016 (Puli) Fucosidosis 59.50 8219 Brachyuria (stumpy tail) 59.50 (English Springer Spaniel) 8323 (, Australian Stumpy Tail Cattle Dog, Austrian Pinscher, Gallbladder mucoceles 59.50 Bourbonnais Pointer, , Brazilian Terrier, Spaniel, (, , English Cocker Spaniel, Pomeranian, , Danish/Swedish Farmdog, , Karelian ) Bear Dog, , , Pyrenean Shepherd, Savoy 8077 Sheepdog, , Spanish Waterdog, , Welsh Corgi) Glanzmann Thrombastenia (GT) 59.50 8184 C3-Deficiency (C3) 59.50 (Pyrenean Mountain Dog) 8007 (Brittany Spaniel) Globoid cell leukodystrophy / Krabbe-disease 59.50 8012 Canine leukozyte adhesion deficiency (CLAD) 59.50 (Cairn Terrier, Irish , West Highland White Terrier) 8322 (, Irish Red and White Setter) Glycogen storage disease GSD Ia 59.50 8330 Canine multi-focal retinopathy (CMR1/2/3) 77.50 (Maltese) 8513 (American , Australian Shepherd, , , , Glycogen storage disease GSD II (Pompe disease) 59.50 Coton de Tulear, Dogo Canario, , English Bulldog, English (, , ) , Finnish Lapphund, , Lapponian Herder, 8156 Pyrenean Mountain Dog, Swedish Lapphund) Glycogen storage disease GSD IIIa 59.50 (Curly Coated Retriever) 8575 8066 e to owner + + + Invoice to owner + + + Invoice to owner + + + Invoice to owner + + + e to owner + Invoice Canine multiple system degeneration (CMSD) 59.50 GM1-Gangliosidosis (GM1) 59.50 (Chinese Crested, ) (Portuguese Waterdog, , ) 8073 8208 Centronuclear myopathy (CNM) 59.50 GM2-Gangliosidosis (GM2) 59.50 (, Labrador Retriever) (Japanese Chin, Toy ) 8314 8098 Cerebral dysfunction (CDFS) 59.50 Grey syndrome (GCS) 59.50 () (Canine cyclic neutropenia) 8316 Chonrodysplasia (dwarfism) 59.50 (Collie) 8232 (, , ) Haemophilia A (factor VIII - deficiency) 77.50 8326 Cleft lip/palate and syndactyly (CLPS) 59.50 (, German Shepherd, Havanese, Old English Sheepdog) 8221 (Nova Scotia Duck Tolling Retriever) Haemophilia B (factor IX - deficiency) 77.50 8120 Collie eye anomaly (CEA) * ̓ ** Optigen 157.00 (Lhasa Apso, Rhodesian Ridgeback) 8304 8319 Collie eye anomaly (CEA)* partner laboratory 59.50 Haemorrhagic diathesis (Scott syndrome) 59.50 (Australian Shepherd, , , Boykin Spaniel, , (German Shepherd) 8449 , Longhaired Wippet, Nova Scotia Duck Tolling Retriever, Hereditary ataxia (HA) 59.50 Rough/, Shetland Sheepdog, ) (, Old English Sheepdog) 8256 8157 Cone degeneration (CD) * ̓ ** Optigen 167.00 Hereditary cataract (HSF4) 59.50 (Alaskan Malamute, Australian Shepherd, German Shorthaired Pointer) (Australian Shepherd, Wäller) 8434 8576 Congenital hypothyroidism with goiter (CHG) 59.50 Hereditary cataract (HSF4)* 59.50 (, French Bulldog, , Spanish Waterdog, ) (, French Bulldog, Staffordshire ) 8317 8672 Congenital ichthyosis 59.50 Hereditary nasal parakeratosis (HNPK) 59.50 (Great Dane) (Greyhound) 8206 8421 Congenital myasthenic syndrome (CMS) 59.50 Hereditary nasal parakeratosis (HNPK) 103.00 (, Jack Russell Terrier, Labrador Retriever, Old Danish (Labrador Retriever) 8179 , ) Hereditary neuropathy (GHN) 59.50 8011 Congenital stationary night blindness (CSNB) 59.50 (Greyhound) 8154 () Hyperurikosuria (SLC) 59.50 8034 Copper storage disease - Copper toxicosis 59.50 (all breeds) 8443 () Hypomyelination / Shaking puppy syndrome (SPS) 59.50 8348 Craniomandibular osteopathy (CMO) 59.50 (English Springer Spaniel, ) 8555 (Cairn Terrier, , West Highland White Terrier) Ichthyosis 59.50 8013 Cystinuria 59.50 () 8481 (, Continental Bulldog, English Bulldog, French Bulldog, Ichthyosis* 59.50 Labrador Retriever, Landseer, Newfoundland, Mastiff, , Olde (Golden Retriever) English Bulldog) 8475 Imerslund-Gräsbeck syndrome (IGS) 59.50 8260 Dandy-Walker-like malformation (DWLM) 59.50 (Beagle, Border Collie) 8198 (Eurasian) Junctional epidermolysis bullosa (JEB) 59.50 8485 Degenerative myelopathy (DM) exon 1 59.50 (German Shorthaired Pointer) 8459 () Juvenile epilepsy (JE) 59.50 8158 Degenerative myelopathy (DM) exon 2 77.50 () 8271 (all breeds) Juvenile laryngeal paralysis & polyneuropathy 59.50 8472

Digital hyperkeratosis (DH/HFH) 59.50 (JLPP) (Dogue de Bordeaux, , Kromfohrländer) (, ) 8406 8557 Dry eye curly coat syndrome (CCS) 59.50 Juvenile myoclonic epilepsy (JME) 59.50 (Cavalier King Charles Spaniel) (Rhodesian Ridgeback) 8643 8125 Dystrophic epidermolysis bullosa (DEB) 59.50 L-2-hydroxyglutaric aciduria (L2HGA) 59.50 (Central Asian Shepherd) (Staffordshire Bull Terrier) 8484 8270 Ectodermal dysplasia/Skin fragility syndrome 59.50 Lagotto storage disease (LSD) 59.50 (ED/SFS) (Lagotto Romagnolo) 8493 (Chesapeake Bay Retriever) Late onset ataxia (LOA) 59.50 8311 Epidermolytic hyperkeratosis (EHK) 59.50 (Jack Russell Terrier, Parson Russell Terrier) 8487 () polyneuropathy 1 (LPN1) 59.50 (Leonberger) + Invoice to owner Invoic + Invoice to owner Invoic

Hereditary diseases € € 8494 8226 Leonberger polyneuropathy 2 (LPN2) 59.50 Primary lens luxation (PLL) 59.50 (Leonberger) (, American Hairless Terrier, Australian Cattle Dog, 8327 Chinese Crested, Danish Svedish Farmdog, Fox Terrier, Jack Russell Terrier, Leukocyte adhesion deficiency type III (LAD3) 59.50 Jagd Terrier, , Lancashire Heeler, Lucas Terrier, Miniature Bull (German Shepherd) 8579 Terrier, Norfolk Terrier, , Parson Russell Terrier, , Lundehund syndrome (LHS) 59.50 Pug Dog, Rat Terrier, , , Tenterfield () Terrier, , , , , 8217 Macrothrombocytopenia (MTC) 59.50 Westphalia Terrier, ) 8452 (Bichon Frise, Boxer, Cairn Terrier, Cavalier King Charles Spaniel, Chihuahua, Primary open angle glaucoma (POAG) 59.50 Cocker Spaniel, Havanese, Jack Russell Terrier, Labrador Retriever, Maltese, (Basset Fauve de Bretagne, Basset Hound, Beagle, Norwegian Elkhound) 8641 Norfolk Terrier, Parson Russell Terrier, Poodle, Shih Tzu) Primary open angle glaucoma and lens luxation 59.50 8062 Malignant hyperthermia (MH) 59.50 (POAG/PLL) (all breeds) () 8312 8492 May-Hegglin anomaly (MHA) 59.50 Protein losing nephropathy (PLN) 59.50 (Pug Dog) (Irish Soft-Coated Wheaten Terrier) 8032 8104 MDR1- defect* (Ivermectin hypersensibility) 59.50 Pyruvate dehydrogenase phosphatase 1 deficiency 59.50 (Australian Shepherd, Border Collie, Elo, German Shepherd, Longhaired (PDP1) Whippet, McNab, Old English Sheepdog, Rough/Smooth Collie, Shetland (Clumber Spaniel, ) Sheepdog, Silken Windhound, Wäller, ) 8015 Pyruvate kinase deficiency (PK) 59.50 8306 Mucopolysaccharidosis type IIIa (MPS3a) 59.50 (Basenji, Beagle, Cairn Terrier, Labrador Retriever, Pug Dog, West (Newzealand , Wirehaired Dachshound) Highland White Terrier) 8069 8394 Mucopolysaccharidosis type VII (MPS7) 59.50 Raine syndrome 59.50 (Brazilian Terrier, German Shepherd) (Border Collie) 8068 8301 Muscular dystrophy (MD) 59.50 Renal cystadenocarcinoma and nodular fibrosis 59.50 (Cavalier King Charles Spaniel, Golden Retriever, Landseer, Norfolk Terrier) (RCND) 8411 Musladin-Lueke syndrome (MLS) 59.50 (German Shepherd) 8150 (Beagle) Retinal dysplasia (OSD) * ̓ ** Optigen 167.00 8220 Myostatin mutation (Bully-gene) 59.50 (Labrador Retriever, Samoyed) 8392 (Whippet) Retinal dysplasia (OSD)* partner laboratory 59.50 8022 Myotonia congenita 59.50 (Labrador Retriever) 8596 (Australian Cattle Dog, ) Sensory neuropathy (SN) 59.50 8067 Narcolepsy 59.50 (Border Collie) 8328 (Dachshound, , Labrador Retriever) Severe combined immuno deficiency (SCID) 59.50 8429 Necrotizing meningoencephalitis (NME/PDE) 59.50 (Frisian , Jack Russell Terrier, Parson Russell Terrier) 8642 (Pug Dog) Shar Pei autoinflammatory disease (SPAID) 59.50 8172 Nemalin myopathy (NM) 59.50 (Shar Pei) 8456 (American Bulldog) Skeletal dysplasia 2 (dwarfism) (SD2) 59.50 8457 Neonatal cortical cerebellar abiotrophy (NCCD) 59.50 (Labrador Retriever) 8605 (Beagle, Magyar ) Spinal dysraphism (NTD) 59.50 8155 Neonatal encephalopathy with seizures (NEWS) 59.50 (Weimaraner) 8537 (Standard Poodle) Spinocerebellar ataxia (SCA) 59.50 8308 Neuroaxonal dystrophy (NAD) 59.50 (Fox Terrier, Jack Russell Terrier, Parson Russell Terrier, Tenterfield Terrier) 8335 (Papillon, Spanish Waterdog) Spondylocostal dysostosis (Comma defect) 59.50 8075 Neuronal ceroid lipofuscinosis (NCL) 59.50 (Miniature Schnauzer) 8610 (American Bulldog, Australian Cattle Dog, Australian Shepherd, Border Collie, Spongy degeneration with cerebellar ataxia 59.50 Chihuahua, Chinese Crested, Dachshound, , Golden Retriever, type 1 (SDCA1) Gordon Setter, Tibetan Terrier) () 8396 8582 Neuronal ceroid lipofuscinosis (NCL)* 59.50 Spongy degeneration with cerebellar ataxia 59.50 (American Staffordshire Terrier) type 2 (SDCA2) 8602 Obesity 59.50 (Belgian Shepherd) 8191 (Flat Coated Retriever, Labrador Retriever) Startle disease 77.50 8215 e to owner + Invoice Osteogenesis imperfecta (brittle bone disease) 59.50 (Irish Wolfhound) 8673 (Beagle, Dachshound, Golden Retriever) Subacute necrotising encephalopathy (SNE) 59.50 8630 Paroxysomal dyskinesia (PxD) 59.50 (Yorkshire Terrier) 8486 (Irish Soft-Coated Wheaten Terrier) Thrombopathia 59.50 8462 Persistent Müllerian duct syndrome (PMDS) 59.50 (Basset Hound, Landseer) 8143 (Miniature Schnauzer) Trapped neutrophil syndrome (TNS) 59.50 8017 Phosphofructokinase deficiency (PFKD) 59.50 (Border Collie) 8393 (American Cocker Spaniel, English Springer Spaniel, , Whippet) van den Ende-Gupta syndrome (VDEGS) 59.50 8142 Pituitary dwarfism 59.50 (Fox Terrier) 8302 (Czechoslovakian Wolfdog, German Shepherd, Saarlooswolfdog) Vitamin-D dependent rickets (VDR) 59.50 8476 Polycystic kidney disease (PKD) 59.50 (Pomeranian) 8119 (Bull Terrier) von-Willebrand disease type I (vWD1) 59.50 8053 Postoperative haemorrhage (P2Y12) 59.50 (Bernese Mountain Dog, Coton de Tulear, Dobermann, Drentsche Patrijshond, (Great ) , Kerry Blue Terrier, , Papillon, Pembroke 8141 Welsh Corgi, Poodle, Stabyhoun) Prekallikrein deficiency (KLK) 59.50 8014 (Shih Tzu) von-Willebrand disease type II (vWD2) 59.50 8483 Primary ciliary dyskinesia (PCD) 59.50 (German Shorthaired Pointer, German Wirehaired Pointer) 8233 (Old English Sheepdog) von-Willebrand disease type III (vWD3) 59.50 8321 Primary hyperoxaluria (PH) 59.50 (, Scottish Terrier, Shetland Sheepdog) 8347 (Coton de Tulear) Warburg micro syndrome 1 (WARBM1) 59.50 (Husky) 8063 X-chromosomal severe immuno deficiency 59.50 (Basset Hound, Welsh Corgi) 8305 X-linked myopathy (XL-MTM) 59.50 (Labrador Retriever, Rottweiler) ______

Requests, wishes, ... ______

* Partnerlab ** no breeders discount 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. Progressive retinal atrophy € €

8574 8094 Bas-PRA1 59.50 prcd-PRA * ̓ ** Optigen 167.00 8127 (Basenji) prcd-PRA* partner laboratory 77.50 8375 CNGA1-PRA 59.50 (American Cocker Spaniel, American Eskimo Dog, Australian Cattle Dog, (Shetland Sheepdog) Australian Shepherd, Australian Stumpy Tail Cattle Dog, , Bolognese, 8135 Bolonka Zwetna, Chesapeake Bay Retriever, Chihuahua, Chinese Crested, crd-PRA 59.50 English Cocker Spaniel, , , Finnish (Wirehaired Dachshound) Lapphund, German , , Golden Retriever, Karelian Beardog, 8332 crd1-PRA 59.50 , Labrador Retriever, Lagotto Romagnolo, Lapponian Herder, (American Staffordshire Terrier) Markiesje, Norwegian Elkhound, Nova Scotia Duck Tolling Retriever, Portuguese 8333 Water Dog, Poodle, Schipperke, Silky Terrier, , Swedish crd2-PRA 59.50 Lapphund, Wäller, Yorkshire Terrier) 8042 (American Pitbull Terrier) rcd1-PRA 59.50 8042 Dominant PRA 59.50 (Irish Setter, Irish Red and White Setter) 8042 (Bull Mastiff, ) rcd1a-PRA 59.50 8451 Generalized PRA 59.50 (Sloughi) 8309 () rcd2-PRA 59.50 8200 GR_PRA1 59.50 (Collie) 8042 (Golden Retriever) rcd3-PRA 59.50 8520 GR_PRA2 59.50 (, Chinese Crested Dog) 8435 (Golden Retriever) rcd4-PRA 59.50 8573 pap_PRA1 59.50 (Australian Cattle Dog, English Setter, Gordon Setter, Irish Setter, Irish Red & (Papillon, Phalène) White Setter, Polish Lowland Sheepdog, Poodle, Small Munsterlander, Tibetan 8444 Terrier) Type A-PRA * ̓ ** Optigen 167.00 8608 (Miniature Schnauzer) XL-PRA 59.50 (Samoyed, Husky) ______

Coat colours / Coat length 8458 EG-locus (domino, grizzle) 59.50 8144 A-locus (alleles: Ay, Aw, at, a) 59.50 (Afghan Hound, Barsoi, Saluki) 8180 EH-locus (sable) 59.50 8023 B-locus (brown, chocolate, liver(nose)) 59.50 (English Cocker Spaniel) 8146 EM-locus (melanistic mask) 59.50 8644 e to owner + + + Invoice to owner + + + Invoice to owner + + + Invoice to owner + + + e to owner + Invoice C-locus caL (albino) 59.50 8195 (Lhasa Apso, Pekingese, Pomeranian) Furnishing (wire hair) 59.50 8124 Coat length I (long or short hair) 59.50 8599 Additional gene loci have to be analysed for complete characterisation in Hairlessness (powderpuff) 59.50 the following breeds: (Chinese Crested Dog, Mexican Hairless Dog, Peruvian Hairless Dog) 8397 8254 Coat length II (long or short hair) 59.50 H-locus (harlequin) 59.50 (Afghan Hound, Inu, Alaskan Malamute, , Eurasian, (Great Dane) Husky, Prague Rattler, Samoyed) 8405 Improper coat 59.50 (Portuguese Waterdog) 8196 8145 Curly (curled hair) 59.50 K-locus (test for KB allele only) 59.50 (Please note: the alleles kbr (brindle) and ky cannot be determined by this test) 8136 D-locus d1 (dilution) 59.50 8188 M-locus* (alleles: Mh, M, Ma, Mc, m) 59.50 8636 D-locus d2 (dilution) 59.50 (Chow Chow, Rhodesian Ridgeback, Sloughi) 8578 Panda white spotting 59.50 8018 E-locus e1 (apricot, cream, lemon, red, yellow) 59.50 (German Shepherd) 8307 Saddle-tan 59.50 8126 E-Lokus e2 (apricot, cream, lemon, red, yellow) 59.50 (Basset Hound, Welsh Corgi) 8438 (Australian Cattle Dog) S-locus * ̓ ** (piebald, white spotting) 59.50

If more than one characteristic is requested we charge 59.50 € for the first and 25.00 € for each additional test (except S-locus).

______

DNA-profiling ISAG 2006 8107 DNA profile (genetic fingerprint) ** 42.00 €

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

8109 Parentage analysis (paternity test) ** each parent 42.00 € each offspring 60.00 €

A DNA profile of each parent is necessary for parentage verification. If only one parent is available, this should be discussed prior to sample submission.

8211 8212 Breed determination (database analysis) ** 115.00 € Likelihood ratio calculation (analysis of blood relationship) ** 115.00 €

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

Newsletter/Webshop: We would like to point you towards our versatile online offers. Our webshop www.labogen.com is online 24/7 and orders are just one click away. Register for our "Genetic News" as well, to receive information about recent genetic developments and health issues.

General terms and conditions: Prices in Euro incl. VAT (19%) An additional fee of 2.80 € for postage and packing applies/ Services offered and prices may be subject to change / 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 - 011011060 / 1712 + Invoice to owner Invoic