<p> 1</p><p>FORM: DM-SAOBC/2013.1</p><p>LAB REFERENCE DELTAMUNE Sample Submission Waybill Account for SAOBC </p><p>FARM NAME REG NUMBER (Ostrich (Ostrich Compartment) Compartment) SAMPLING OFFICIAL LABORATORY DELIVERY ADDRESS: Title Initials Surname DELTAMUNE Oudtshoorn Laboratory Postal Address BOKOMO Premises Town 15 – 17 Rademeyer Street Postal Code OUDTSHOORN Province 6625 Tel Fax Tel: 044 272 7159 Cell E-Mail Fax: 044 272 7152</p><p>STATE VETERINARIAN OWNER OF OSTRICHES Title Initials Title Initials Surname Surname Postal Address Physical Address / Farm Name</p><p>Province District Prov Tel Fax Tel Fax</p><p>ANIMALS TEST REQUIRED (Please tick appropriate box) Species OSTRICH Serology Testing (Serum) Total Census of Ostriches on Farm Avian Influenza ELISA .X. Production Refer to attached list Molecular Testing (Swabs) group / age: TYPE OF SPECIMEN Avian Influenza Virus .X. Number of Serum Number of Tracheal Swab Samples Pools Newcastle Disease Virus .X. PURPOSE OF TESTING: (Compulsory) Number of Other Samples (i.e. Pre-movement/Surveillance/Follow-up test etc.) Specify: e.g. Organ / Cloacal Swabs / Faeces etc. SAMPLING DATE</p><p>248 Jean Avenue, Lyttelton, Centurion • PO Box 14167, Lyttelton, 0140, South Africa • Tel: +27(0)861 133 582 • Fax: +27(0)861 133 582 Email: [email protected] • Website: www.deltamune.co.za</p><p>Directors: Mr CM Bates (Chairman) • Mr SA Bentz • Dr EE de Bruyn • Mr RJ Franklin • Mr MA Mahlalela • Dr SP Swanepoel • Dr JC Swart (CEO)</p><p>Registered name: DELTAMUNE (PTY) LTD • 1994/005981/07 LIST OF OSTRICHES SAMPLED FOR AVIAN INFLUENZA Date Farm Name Reg Number Sampled (Ostrich Compartment ) (Ostrich Compartment)</p><p>PRODUCTION GROUP</p><p>7 wk – 5 mnth - Breeder 7 wk – 5 mnth - Breeder 7 wk – 5 mnth - Breeder 7 wk – 5 mnth - Breeder 4 mnth older birds 4 mnth older birds 4 mnth older birds 4 mnths older birds r r r r r r r r e e e e e e e e b b b b b b b b m m m m m m m m u u u u u u u Tag Number u Tag Number Tag Number Tag Number N N N N N N N N</p><p> l l l l e e e e o o o o b b b b o o o o u u u u P P P P T T T T 1 31 61 91 2 32 62 92 3 9</p><p>1 3 7 33 63 93 1 1 4 34 64 94 5 35 65 95 6 36 66 96 7 37 67 97 4 0</p><p>2 8 8 38 68 98 1 2 9 39 69 99 10 10 40 70 0 10 11 41 71 1 10 12 42 72 2 10 5 1 3 9</p><p>13 43 1 73 2 3 10 14 44 74 4 10 15 45 75 5 10 16 46 76 6 10 17 47 77 7 10 0 6 2 4</p><p>18 1 48 1 78 2 8 10 19 49 79 9 11 20 50 80 0 11 21 51 81 1 11 22 52 82 2 11 1 7 3 5</p><p>23 1 53 1 83 2 3 11 24 54 84 4 11 25 55 85 5 11 26 56 86 6 2 8 4 6</p><p>1 1 2 11 27 57 87 7 2 11 28 58 88 8 29 11 59 89 9 12 30 60 90 0</p><p>3 LIST OF OSTRICHES SAMPLED FOR AVIAN INFLUENZA Date Farm Name Reg Number Sampled (Ostrich Compartment ) (Ostrich Compartment)</p><p>PRODUCTION GROUP</p><p>7 wk – 5 mnth Breeder 7 wk – 5 mnth Breeder 7 wk – 4 5 mnth Breeder 7 wk – 4 5 mnth Breeder 4 mnth - older birds 4 mnth - older birds mnth - older birds mnths - older birds r r r r r r r r e e e e e e e e b b b b b b b b m m m m m m m m u u u u u u u u Tag Number Tag Number Tag Number Tag Number N N N N N N N N</p><p> l l l l e e e e o o o o b b b b o o o o u u u u P P P P T T T T</p><p>12 15 18 21 1 1 1 1 12 15 18 21 2 2 2 2 12 5 15 18 21 2 3 3 3 3 12 15 18 21 4 4 4 4 12 15 18 21 5 1 5 7 5 3 5 3 3 4</p><p>12 15 18 21 6 6 6 6 12 15 18 21 7 7 7 7 12 6 15 18 21 2 8 8 8 8 12 15 18 21 9 9 9 9 13 16 19 22 0 2 0 8 0 4 0 3 3 4</p><p>13 16 19 22 1 1 1 1 13 16 19 22 2 2 2 2 13 7 16 19 22 2 3 3 3 3 13 16 19 22 4 4 4 4 13 16 19 22 5 3 5 9 5 5 5 3 3 4</p><p>8 13 4 0 6 2 3 16 4 19 4 22 6 6 6 6 13 16 19 22 7 7 7 7 13 16 19 22 8 8 8 8</p><p>4 13 16 19 22 9 9 9 9 14 17 20 23 0 0 0 0</p><p>14 17 20 23 1 1 1 1 14 17 20 23 2 2 2 2</p><p>9 14 17 1 20 7 23 2 3 3 4 3 4 3 14 17 20 23 4 4 4 4 14 17 20 23 5</p><p>5 3 5 5 5</p><p>14 17 20 23 6 6 6 6 14 17 20 23 7 7 7 7 0 14 17 20 23 3 8 8 8 8 14 17 20 23 9 9 9 9 15 18 21 24 6 2 8</p><p>0 3 0 4 0 4 0</p><p>5</p>