I THE UNDERSIGNED DECLARE
THAT I HAVE TODAY IMPLANTED THE MICROCHIP, NUMBERED:
Microchip No .. <Affix Barcode Here. SCANNED Yes / No
I CONFIRM THAT THE HAIR
SAMPLES ENCLOSED WITH THIS DECLARATION WERE TAKEN BY ME AT THE TIME AND PLACE
OF INSPECTION AS SHOWN
* Broodmare / Dam Registration No
. Sample
enclosed Yes/No
* Foal: Sired by:
... Foal
Sample enclosed Yes/No
AT (ADDRESS)
.
AND I CONFIRM THAT THEIR
IDENTIES CONFORM TO THAT SHOWN ON THEIR REGISTRATION (APPLICATION) or PASSPORT
Horse Name
.. Reg No
..
* Dam Name:
Sire Name:
.
* The
above Equine/s have been marked up by myself and on the attached
Registration Form the microchip number barcode has been affixed
* The
above Equine/s have been verified by myself against their Passport /
Registration papers and the microchip barcode has been affixed
* Delete as applicable
SIGNED:
Veterinary Surgeon or STAGBI Official
VETERINARY PRACTICE or
STAGBI STAMP (MANDATORY)
DATE:
. TIME
OWNERS NAME
SIGNED BY OWNER
..
STAGBI Membership Number
..
OWNERS ADDRESS
.
.
County
.. Post
Code
TEL No
The date, inspection
address, horses name and registration number must be given in BLOCK CAPITALS or
typed.
This Copy to be
returned to STAGBI when fully completed. In the envelope provided
STAGBI,
Little Craig, Llandegley, Powys,