Notice of intention to supply
Hormonal Growth Promotants
Declaration
I, (enter your full name)
being (enter your role at business)
notify the Australian Pesticides and Veterinary Medicines Authority that (enter the registered name of business)
ACN ABN
intends to supply Hormonal Growth Promotants (HGPs) from the premises located at:
Street address:
Address line 1:
Address line 2:
Suburb:
State:
Postcode:
Postal address (if same as business street address, leave blank):
Address line 1:
Address line 2:
Suburb:
State:
Postcode:
Phone number: Mobile number:
Email address:
Our business previously held HGP notification number (if applicable): NRA:
Form continues on page 2
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Notice of intention to supply
Hormonal Growth Promotants
I understand that under the Agvet Regulations my employees and/or agents are required to:
1. record all acquisitions and disposals of HGPs and to submit these records to the APVMA within 14 days of the
end of each calendar month
2. keep copies of the records of acquisition and disposal for two years
3. supply all purchasers with information sheets if required
4. allow inspections of stocks and records of HGP products by APVMA inspectors when required
5. retain original copies of purchaser declaration forms for two years
6. not supply any HGPs directly to a recipient that is either:
a) a retailer or wholesaler (not an end-user), unless they provide their current HGP notification number,
or
b) an end-user or their representative, unless the person seeking to purchase the HGPs first completes
and submits a signed purchaser declaration form.
I acknowledge that the name and address of the business and the expiry date of the notification number will be
included on a list of registered sellers of HGPs (made available on the APVMA website) enabling confirmation of
the businesses authority to obtain and supply HGPs.
I acknowledge that details of supply of HGPs to end-users will be provided to state and territory authorities to enable
them to arrange on-farm audits of cattle producers.
Signature:
___________________________________________
Date:
How to submit your form
Send the completed electronic form to HGP@apvma.gov.au
Contact us
To obtain further information, please visit our website or contact the APVMA:
Email: HGP@apvma.gov.au
Phone: + 61 2 6770 2302
For information on how the APVMA manages personal information when you complete and submit a form, see our
Privacy Policy.
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signature
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