To Operate as Veterinary Wholesale Dealer
ID Card No
Building Entry Point Name
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 owner of the wholesale dealing activity If the details are the same as in Page 1 fill in only the field entitled 'Telephone'
Name of the wholesale dealing activity and details of the operational site
Are activities other than the distribution of veterinary products carried out from the operational site ?
Description of any other activities apart from the distribution of veterinary medicinal products (if applicable)
Categories of veterinary medicinal products planned to be handled
In case of others please specify
Product Classes planned to be handled
Details of the legal site of the wholesale dealer (if applicable)
Same site as Operational Site (If not fill in the below)
Description of the activities to be carried out from this site
Details of the bonded stores site (if applicable)
Tax Warehouse Number
Details of the Responsible Person (RP)
Pharmacist registration number
Declaration from the Responsible Person (RP)
I will inform the Veterinary Medicines Section in writing of any delegated tasks that I give to other persons. A signed declaration shall also be submitted when my duties with the wholesale dealer are terminated. To the best of my knowledge and belief the particulars I have given in this application form are correct and complete.
Declaration from the wholesale dealer
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. As wholesale dealer I am not a veterinary surgeon, nor do I have any business agreement with any veterinary surgeon. 3. 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.4. To the best of my knowledge and belief the particulars I have given in this application form are correct and complete.