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DELTAMUNE Sample Submission Waybill
Account for DAFF
OBC Farm Reg/Sender Ref No:
Submission Date:
Details of Sender
Title:
Lab Number:
Delivery Address:
Initials:
DELTAMUNE Oudtshoorn Laboratory
Surname:
BOKOMO Premises
Postal Address:
15 – 17 Rademeyer Street
OUDTSHOORN
Tel: 044 272 7159
Tel:
Fax:
Cell:
E-Mail:
Fax: 086 759 4855
Details of Farm
Municipal Registered Farm Name:
GPS Coordinates
DEGE:
(Degrees East)
State Veterinarian
Title:
Municipal Registered Farm Number:
DEGS:
(Degrees South)
Owner of Animals
Initials:
Title:
Surname:
Surname:
Postal Address:
Physical Address:
Province:
Province:
Tel:
Signature:
Fax:
Tel:
Initials:
Fax:
Cell:
PTO
248 Jean Avenue, Lyttelton, Centurion • PO Box 14167, Lyttelton, 0140, South Africa • Tel: +27(0)861 133 582 • Fax: +27(0)861 133 582
Email: info@deltamune.co.za • Website: www.deltamune.co.za
Directors: Mr SA Bentz • Dr EE de Bruyn • Mr RJ Franklin • Dr SP Swanepoel • Dr JC Swart (CEO)
Registered name: DELTAMUNE (PTY) LTD • 1994/005981/07
DELTAMUNE Sample Submission Waybill
Account for DAFF
Animals
Purpose of testing - Please tick appropriate box
Species: OSTRICH
Pre-slaughter
.X.
Total census of Ostriches on farm:
Pre-movement
.X.
Age: Refer to back of page with bird numbers
6 monthly testing
.X.
Type of Specimens
Follow-up on positive test results
Serum: No of samples
.X.
Tracheal Swabs: No of swab pools
Date of first positive result: .................................
Other samples: e.g. Organs/Cloacal swabs/Faeces
Specify other samples: .....................................................
Sampling date: ..................................................................
Detailed explanation for purpose of testing including relevant farm history
For office use only
DAFF:
Approved/Not Approved
Stamp and Signature:
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