e-form

To Open and Operate a Medicated Feed Mill

Issue date

ID Card No

Passport No

Title

Name

Surname

Door Name

Door Number

Building Entry Point Name

Street Name

Locality Name

Post Code

Mobile

E-mail

Date

Disclaimer on personal data

The Animal Health and Welfare Department collects and processes information to carry out its functions under the Veterinary Services Act (Chapter 437) together with its subsidiary legislation. All personal data collected is processed according to the principles specified in the General Data Protection Regulation (EU 2016/679) and the Data Protection Act (Chapter 586). Such data may be disclosed to other departments and/or authorities which are directly related to the functions pertaining to the Animal Health and Welfare Department and the legislation mentioned above, however it will not be disclosed to other third parties unless obliged by law.

Details of the medicated feed mill owner

If the details are the same as in Page 1 fill in only the field entitled 'Telephone'

Name

Surname

Door number/name

Street name

Post code

Location name

Telephone

Mobile

E-mail

Details of the medicated feed mill

Proposed name

Door number/name

Street name

Post code

Location name

Telephone

Mobile *

E-mail

Planning Authority Permit

Feed business operator approval/registration

Other premises adjoined to the medicated feed mill

Description of any other activities carried out by the operator in the premises adjoined to medicated feed mill (mark n/a if non-applicable)

Details of the Technical Person

Door number/name

Street name

Post code

Location name

Telephone

Mobile *

E-mail

ANNEX I

Declaration from the technical person

I will inform the Veterinary Medicines Section in writing when my duties at the medicated feed mill are terminated.

To the best of my knowledge and belief the particulars I have given in this application form are correct and complete.

ANNEX II

Declaration from the medicated feed mill owner

1. The activities are to be carried out only in accordance with the information set out in this application form or furnished in connection with it.

2. I will immediately inform in writing the Veterinary Medicines Section should I undertake an activity which to date is not mentioned in this application form.

3. I will operate by the principles of Hazard Analysis and Critical Control Points (HACCP) and will update the plan according to the needs.

ANNEX III

Documents to be attached with the application form

*Not mandatory