Sign and fax/email this form to the point of entry: Kununurra Fax +61 (0)8 9166 4067 or +61 (0)477 757 185 (after hours) Email [email protected] Kalgoorlie Fax +61 (0)8 9093 4839 or +61 (0)8 9091 9854 (after hours) Email [email protected] Perth Fax +61 (0)8 9334 1880 Email [email protected] Note: A signed copy must accompany the stock. Declaration of Origin Equines, ruminants and camelids from the Liver Fluke Test Exempt Area of Australia Biosecurity and Agriculture Management Act 2007 (BAMA) and Regulations 2013 This declaration provides evidence for the exemption of the described livestock from pre-entry testing and/or pre- entry treatment for liver fluke on movement into Western Australia on the basis that the stock have been born and grazed solely in the Liver Fluke Test Exempt Area of Australia and is to be attached to the Health certificate for movement of stock to Western Australia (Form LB 1). A border treatment may still apply.

Animal species Number Sex Age Description and identification (include Property official name/s of registered animal/s) identification code (PIC)

I, of Town: State/Territory: Postcode: Telephone: Email: being the owner of the livestock described above, declare that these stock were born and have grazed solely within the area defined below as the Liver Fluke Test Exempt Area of Australia. Declared at this day of 20

Signature of person making the declaration Signature of witness (witness must be a registered Commonwealth elector) Name of witness (block letters): Telephone: Address: Postcode: Definition The Liver Fluke Test Exempt Area of Australia means: 1. The Northern Territory. 2. Queensland, north and west of the line of the road which runs from Hungerford to Thargomindah to Quilpie to Adavale to Blackall to Jericho to Alpha to Clermont to Mount Douglas on the Gregory Development Road, to Bowen via Collinsville on the Bowen Development Road. 3. South Australia, north of Highway 32 from the New South Wales border to Peterborough, Highway 83 from Peterborough to Carrieton, and north of the boundaries of the Counties of Dalhousie and Frome from Carrieton to Port Augusta, and those areas of the Eyre Peninsula north of County Flinders.

Livestock Biosecurity Form LB 5 - current as at 28 November 2016 Page 1 of 1