PigPass Registration On-line Application
Fill out the questions that are relevant to you. Some questions may not apply.
Use this form if you are a:
Producer
Supplier of Veterinary Medicines
Supplier of Pesticides
Feedstuff Supplier
Agent
Saleyard
Livestock Transport
Processor
Retailer or Wholesaler
International or Domestic buyer
Government Department
Industry service provider (Auditor, Veterinarian, Equipment Vendor, Journalist or interest party)
Note: this is an application only and submission of this form does not indicate that you have or will be registered. You will be contacted by APL personnel before any registration is completed.
Registered business/ trading name/ Government department:
Other Trading Name(s):
Is this the primary site of a multi site operation?
No
Yes
Type of Entity:
Sole Trader
Partnership
Australian Private Company
Public Company
Charitable or not-for-profit organisation
Association
Research Entity
State Authority
ABN, ARBN or ACN:
APL member?
Yes / No
Yes
No
Existing APL membership number, if applicable:
Type of APL Membership:
01 Full member
02 Associate member
Levy Payer?
Yes / No
Yes
No
:
Membership Contact
Name:
Preferred Name:
QA Program:
QA Certificate Number:
QA Program Expiry Date:
(DD/MM/YYYY) Date Issued:
(DD/MM/YYYY)
Property Identification Code (PIC):
Tattoo/ Brand Number:
Additional Tattoo/Brands:
Property Owner:
Property Owner:
Producer:
International Buyer:
Saleyard:
Stock Agent:
Veterinary Medicine Supplier:
Abattoir:
Livestock transport:
Retailer and Wholesaler:
Government Representative:
Industry Service Provider:
Feed Supplier:
I am an Associate Member:
I am a Delegate:
I am an APL contact:
Board member:
Other:
If a producer, Type of producer:
Select
Breeder
Contract grower
Mixer species
Mixer crop and pigs
Farrow to Finish
Rural Lands Protection Board
Other
If a producer, number of Sows:
Primary Contact:
Name:
Preferred Name:
Phone:
Fax:
Mobile:
Email:
Requested Log on:
Password:
Preferred Contact Method:
Phone
Fax
Email
Mail
Security Question:
Pet name
Partner name
Name of Parent
Answer:
Secondary Contact:
Name:
Preferred Name:
Phone:
Fax:
Mobile:
Email:
Requested Log on:
Password:
Preferred Contact Method:
Phone
Fax
Email
Mail
Security Question:
Pet name
Partner name
Name of Parent
Answer:
Primary Authorised Representative:
Secondary Authorised Representative:
Trading/ Property Address of Producer:
Address Line 1:
Address Line 2:
Shire or District:
State:
QLD
NSW
VIC
SA
WA
ACT
NT
TAS
Post Code:
Country:
Australia
China
New Zealand
United Kingdom
United States of America
Postal Address of Producer:
Address Line 1:
Address Line 2:
Shire or District:
State:
QLD
NSW
VIC
SA
WA
ACT
NT
TAS
Post Code:
Country:
Australia
China
New Zealand
United Kingdom
United States of America
Postal Address of owner/ business:
Address Line 1:
Address Line 2:
Shire or District:
State:
QLD
NSW
VIC
SA
WA
ACT
NT
TAS
Post Code:
Country:
Australia
China
New Zealand
United Kingdom
United States of America
Comments: