Commodity Vendor Declaration
Delivery Period____________________________________________
________________________________________________ Quantity__________________________________________________
TOTAL QUANTITY:_________________________________________
1. Commodity
source (tick one)
Single Source, Single Storage (eg off the header) Single Source, Comingled Storage (eg farm silo)
Multi-Vendor Storage (eg grain depot, cotton gin seed storage) Factory Developed Product (eg ethanol plant, gluten plant)
Does this commodity contain restricted animal materials (eg meat and bone meal)?
No Yes
With respect to Genetically Modified Organisms, this commodity: (tick one)
Is non GMO as defined by 99% non GMO Contains greater than 5% GMO or content unknown.
Is non GMO as defined by 95% non GMO
I, _____________
____________________________________of______________________________________________________________declare that:
a) I am the duly authorised representative of the vendor supplying the commodity;
b) All the information in this document is true and correct;
c) I have read, understood and answered all questions in accordance with the explanatory notes;
d) I understand that regulatory authorities may take legal action, and purchasers may seek damages if the information provided is false or
Name: ________________________________________________
Address: ______________________________________________
Town: _________________________________________________
Tel: _______________________ Fax: _______________________
Email: _________________________________________________
National Grower Registration (NGR) No: __________________
Property Identification Code (PIC):________________________
Vendors contract/ reference No:
Name: _________________________________________________
Address: _______________________________________________
Town: __________________________________________________
Tel: _______________________ Fax: ________________________
Email: _________________________________________________
National Grower Registration (NGR) No: __________________
Property Identification Code (PIC):________________________
Buyers contract No:
Part A – Product Integrity
Part C - Declaration
4. Is this commodity within a withholding period (WHP), Export Slaughter Interval (ESI) or Export Animal Feed Interval (EAFI) following
treatment with any plant chemical including a pickling or seed treatment, fumigant, pesticide or insecticide?
No Yes,
enter details in the table below
Chemical applied
Application date
5. Has t
he commodity been grown and/or stored under an independently audited QA program which includes chemical residue
No Yes, pr
ovide details
QA prog
ram________________________________________ Accreditation/ Certification Number___________________________
If this commodity has been grown or stored under such a QA program, please now read and sign Part C. If not, please now complete
the remainder of Part B.
6. Is t
he vendor of this commodity currently aware of its full chemical treatment history or holds a CVD containing this history?
No Yes
7. List all known adjacent crops grown within 100 metres of this commodity (only applicable for single source commodities)
8. If the commodity is a by-product, has a risk assessment been completed? (tick one)
No Yes, attach copy of risk assessment N/A (see explanatory notes)
9. Has the commodity been analysed for chemical residues or toxins by a lab accredited by NATA for the specific test required?
No Yes, attach details of test results
Part B – Chemical Use
May 2014
click to sign
click to edit
For information about the on-farm requirements of LPA accreditation visit:
Who should sign this form?
You should only sign this form if
you are the person representing
the organisation supplying this
commodity and were responsible
for the production and/or
storage of this commodity prior
to dispatch to the buyer.
Ensure that you answer all
questions accurately and that
you understand all elements of
the declaration and these
explanatory notes.
Vendor details
The producer’s trading name or
the name of the commodity
trader must be identified. If the
seller (vendor) of the commodity
is different to the producer or
storage facility, then the
vendor’s name and address
should be filled out.
Enter the Property Identification
Code (PIC) and/or National
Grower Register (NGR) number if
they have been allocated.
The Vendor’s contract no. (if
applicable) is the vendor’s
individual contract number for
the fodder being sold.
Buyer details
The buyers name and address
must be identified.
The Buyer’s contract no. (if
applicable) is the individual
contract number that the buyer
has allocated for the commodity
being purchased.
Commodity Details
List the type of commodity (e.g.
lucerne hay, barley, citrus pulp),
the number of tonnes or bales
and bale size covered by the
declaration, and the start and
finish dates for delivery.
Answers to Question 1 are used
to estimate the potential for
mixing of the commodity. If you
are a commodity trader you
should provide copies of the
individual Vendor Declarations
completed by each supplier.
Vendors should be aware that
contamination could occur
during loading and transport.
Care should be taken that trucks
and bins are clean prior to
loading. Transporters should be
encouraged to use consignment
notes for all loads.
Restricted Animal Material
(RAM) is defined as any material
taken from a vertebrate animal
other than tallow, gelatin, milk
products or oils.
RAM includes rendered products
such as blood meal, meat meal,
meat and bone meal, fish meal,
poultry meal, feather meal, and
compounded feeds made from
these products.
Commodities containing RAM
must not be fed to ruminants.
Only make a declaration on the
percentage of non GMO content
if you are sure of its content. If
you are unsure, declare content
List the full product name (e.g.
XYZ Diuron 900QG) for chemicals
applied to the commodity, whilst
in your control, as well as the
grams per litre or hectare of
product used or the rate per
hectare or tonne, application
date and the relevant
WHP/ESI/EAFI as shown on the
chemical label or APVMA permit.
Include organic fertilisers (eg.
Chicken manure). If there is
insufficient space, attach an
additional sheet in the same
format (columns).
NOTE: The withholding period
(WHP) is the period stated on the
product label or an APVMA
permit that must elapse between
the last application of a chemical
and harvesting for human
consumption or for stockfeed.
NOTE: The export slaughter
interval (ESI) is the minimum
period that must elapse between
the removal of livestock to clean
pasture or feed, and their
slaughter, where the livestock
have been consuming the
treated pasture or feed prior to
the expiry of any export animal
feed interval.
NOTE: The Export Animal Feed
Interval (EAFI) is the minimum
period that must elapse between
the application of a chemical to a
crop or pasture and grazing or
harvesting of the crop or pasture
for stock feed for animals that
may be slaughtered for export.
NOTE: When an EAFI has been
established, and grazing or
feeding has not occurred before
its expiry, the ESI does not need
to be observed.
Answer “Yes” only if the property
of origin or storage facility is
Quality Assurance (QA) certified
to ensure correct management
of chemical residues and is
audited by a third party
NOTE: The Livestock Production
Assurance (LPA) program is not
an approved QA program.
Examples of QA programs
include Chem Check and Fodder
Answer ‘Yes if you are able to
provide residue test results,
complete records of chemical
treatments or commodity
vendor declarations for all
sources of supply of the
commodity. If you are unsure of
the chemical treatment history
of the commodity you must tick
List all crops known to have been
grown within 100 metres of the
crop from which this commodity
was harvested. If a locust control
authority has sprayed in the
area, that use should also be
noted. This includes crops grown
on neighbouring properties.
If the commodity is mixed from
multiple sources, leave the table
blank. As an alternative you
should provide copies of the
individual Commodity Vendor
Declarations completed by each
grower that supplied feed for
this consignment.
This question is intended for by-
products from agricultural and
horticultural production (ie
sugarcane tops or citrus pulp),
from industrial processes (ie
ethanol production) or from any
commodity that was not
intended to feed livestock, but
may legally be fed to livestock (ie
does not contain RAM).
If the commodity was grown for
the purpose of feeding to
livestock, tick N/A.
SAFEMEAT has prepared risk
assessment summaries for major
by-product feedstuffs. These risk
assessment summaries are
available from this link, from
your peak industry body or from
Answer “Yes” if the commodity
covered by this declaration has
been tested for chemical
residues, Annual Ryegrass
Toxicity (ARGT), prussic acid (a
sorghum crop that has been
drought stressed and cut for
fodder is potentially toxic to
livestock due to increased levels
of prussic acid), aflatoxins (for
peanut hay) or nitrites or any
other substances.
Results should be supplied as a
copy of the laboratory’s
certificate of analysis.
NOTE: NATA is the National
Association of Testing
Authorities. Any test performed
should be accredited as part of
the laboratory’s NATA
accreditation to ISO 17025.
Signing this declaration has legal
significance. Regulatory
authorities may take legal action,
and purchasers may seek
damages if information is
incorrect. Before signing you
must be absolutely satisfied you
understand all elements of the
document, and these
explanatory notes.
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