Vendor Declaration

Vendor Declaration

2024/2025 Vendor Declaration

The vendor declaration must precede or accompany each consignment of grain and is required for each commodity supplied and for each separate paddock. Failure to provide a declaration may result in consignment being rejected or deductions made.

Email Address*

Trading Name of Producer*

Vendor Trading Name (if different)

Contact Name*

Address*

Phone Number*

Commodity*

Variety*

Harvest Date*

Property Name (Where Produced)*

Paddock Name*

Approximate Hectares*

NGR ID*

This commodity is supplied direct from producer *

Direct from paddock

Direct from storage

Multi-vendor storage

Multi-Vendor Storage Location/ID*

Is the property on which the property was grown and / or stored certified under a Quality Assurance Program?*

Yes

Quality Assurance Program - If yes*

Has the commodity been grown on a property with an assigned chemical residue status?*

Yes

Chemical Residue - if yes*

Is there any knowledge or reason to suspect that Endosulfan has been applied or come into contact with this commodity?*

Yes

Has the crop been genetically engineered in any way as to be classified as a Genetically Modified Organism (GMO)?*

Yes

Has the commodity been in contact with animal by-products including meat meal, feather meal, animal fat/tallow, offal meal, gelatine, egg or any other animal proteins, including catering waste?*

Yes

Has the storage area that the commodity has come from been in contact with animal by products including meat meal, feather meal, animal fat/tallow, offal meal, gelatine, egg or any other animal proteins including catering waste?*

Yes

Has the commodity been in contact with any antibiotic and/or hormones?*

Yes

Have you got a chemical report to attach (bottom of form)?*

Yes

Chemicals applied to this crop (Excl Fertilisers), Rate per Ha, Application date, WHP/ESI Fodder, WHP/ESI Harvest*

e.g. Activator- 99.24ml/Ha - 12/12/24 - N/A - N/A

Chemicals applied to adjoining crops/paddocks on this property (Excl Fertilisers), Rate per Ha, Application date, WHP/ESI Fodder, WHP/ESI Harvest*

e.g. Activator- 99.24ml/Ha - 12/12/24 - N/A - N/A

Chemicals Applied Post Harvest (Incl Fumigants), rate per tonne, application date, WHP/ESI

e.g. Activator- 99.24ml/Ha - 12/12/24 - N/A - N/A

List all neighbours crops within 100m of where this commodity was grown.

e.g. Barley, harvested 5/01/25

Declaration*

I, (enter full name and position below), declare that,

A) I am a duly authorised representative of the vendor supplying this commodity

B) All the information is true and correct

C) Whilst under the vendors control, all chemical applications to the commodity were with registered chemicals in accordance with the chemicals registered label or APVMA permit.

D) The commodity supplied complies with all state/territory legislation in relation to restricted Animal material and feeds for livestock.

E) Any withholding periods (WHP’s) and/or export slaughter intervals (ESI’s) set out on the registered labels or APVMA permits of chemicals applied have been observed and where required, are specified on this declaration.

F) I have read and understood the explanatory notes on page 2 of this declaration and have answered all questions in compliance with the explanatory notes.

Do you agree to have met the requirements for the declaration above?*

Yes

Date of declaration*

File Upload

Drag and drop files here or

Send me a copy of my responses

Privacy Notice|Report Abuse