Inqaba Biotechnical Industries (Pty) Ltd

525 Justice Mahomed Street

Muckleneuk

0002

Pretoria

+27 12 343 58 29

WILDLIFE MOLECULAR TESTREQUEST FORM

Client’s details:

Client’s name:
Address:
Postal code:
Tel/Cell: / E-mail:

ACCOUNT FOR:

Name: / VAT No.:
Address:
Postal code:
Tel/Cell: / E-mail:

Payment and results:

Preferred method of receiving results: / E-mail / Post
E-mail to be sent to:
Method of payment: / Cash / Electronic transfer

***NB NOTE: All Blesbok/Bontebok/Zebra samples will forthwith IS handled directly between client and the National Zoological Gardens (NZG). If you wish us to facilitate this process, a surcharge will be applicable – All these tests require pre-payment before the samples will be processed.

DISCLAIMER: It is the sender’s responsibility to obtain permits when sending samples where required. It is the sender’s responsibility to ensure the correctness of the information accompanying the sent samples. Inqaba Biotechnical Industries (Pty) Ltd. warrants the test results to be accurate for the sample obtained from these animals as identified on this form. In no event shall Inqaba Biotechnical Industries (Pty) Ltd. be liable for indirect, substantial or secondary damages of any kind. No Guarantees are made with regards to turn-around time and results, and no liability accepted for any delays

Animals’details:

NOTE:

The microchip number is required for sub-species tests. It is important to note that only mitochondrial genes are being used in Sub Species analysis and therefore only the Maternal Candidate’s sub-species can be verified. Mitochondrial DNA is inherited from the Maternal Candidate. It is not possible to determine whether the animal is a hybrid based on the data available.

Profiles are used for Parentage Testing. For Sables, Buffalo and Wildebeest, there are two panels available for Profile and Parentage testing.

Panel 1 is the standard panel used to generate a profile and will be utilized as standard.

Panel 2 is an extra panel that will assist in determining parentage in very closely related populations and may be applied after consultation with the client. Additional costs are applicable for Panel 2.

Please ensure the correct tests required are marked clearly.

ANY INCOMPLETE INFORMATION WILL LEAD TO DELAYS WITH PROCESSING YOUR SAMPLES & ADDITIONAL ADMINISTRATION COSTS.

Species / Sample Name/
Ear Tag / Microchip No. / Year of birth / Gender
(F/M) / Genetic Test (select with an "X" all test required)
Profiling / Sub-species
Panel 1 / Parentage**

**Note:Additionalinformationisrequiredforparentageverification

If parentage is required, provide details on possible candidate mothers/fathers/offspring here. If comparison of these samples to previously submitted samples is required, please indicatethe previous Lab no’s here.

**Parentage information:

Sample Label Offspring/Calf / Eartag No. / MicrochipNo. / Maternal Candidate / Paternal Candidate

Additionalinformationonrelationships(e.g.Bull 1isthebrother of Bull2andtheuncleofCow3):

Sample declaration:

Iconfirmthatthesamplesenclosedhavebeencollectedfrom theanimalsdescribedabove. I submit these samples and pedigree for the purpose of DNA testing. I understand that the results of this test will only be reported to the owner listed on this form and that if samples have not be collected correctly or are of low quality, they will not be analysed and will be returned to the sender. I have supplied complete and accurate information to the best of my knowledge.

Owner’sname: _____Signature: ____

Date: ______

Paymentandresults:

Preferredmethodofreceivingresults:E-mail

Methodofpayment:Electronic transfer

Email towhichresultscanbe sent: ______

Storage:

inqababiotec™canstoreyouranimals’sample forupto5years,atnofeetoyou provided there is material left after testing

NostorageBloodsampleDNAsample

*It is important to note that only mitochondrial genes are being used in Sub Species analysis and therefore only the dam’s sub-species can be verified. Mitochondrial DNA is only inherited from the dam. It is not possible to say if the animal is a hybrid based on the data available.

*It is the sender’s responsibility to obtain permits when sending samples where required

*It is the sender’s responsibility to ensure the correctness of the information accompanying the sent samples. Inqaba Biotechnical Industries (Pty) Ltd. warrants the test results to be accurate for the sample obtained from these animals as identified on this form. In no event shall Inqaba Biotechnical Industries (Pty) Ltd. or Global Supplies be liable for indirect, substantial or secondary damages of any kind.

*We reserve the right to decline testing of samples

*No Guarantees are made with regards to turn-around time and results, and no liability accepted for any delays.

*By signing this document, you undertake to pay invoices timeously and in full, and accept that interest may be levied on invoices outstanding for longer than a month from date of issue

Sample collection Protocol:

Blood Samples

Only useEDTA blood collection tubes (Purple Top) to collect blood for DNA analysis. Approximately 2 mL of blood is sufficient for DNA analysis. Thoroughly mix whole blood sample by inverting the tube 5 times.

FTA blood filter cards

These cards can be obtained from Global Supplies. You simply blot a few drops of blood on the card and it can be sent via ordinary post because it is stable at room temperature. Please just ensure you have enough blood (about a blot of 1-2cm x 1-2cm big).

Tissue Samples

Soft tissue samples can be stored at room temperature in a plastic container. Any muscle or skin tissue will work. A sample about the size of a pencil eraser is all that is needed (2 cm x 2cm).

Hair samples

Clean, fresh hair samples will be accepted if there is no alternative. No sample will be stored. No guarantee on successful results. Delays in results can be expected.

Labelling Procedures:

All collected materials should be labelled. Labels should include the species, a unique number and a microchip number.

Storage before Shipment:

Whole blood and tissue samples can be stored in the refrigerator (2 - 6°C) for up to one week. If you need to store the whole blood or tissue samples for longer than a week before sending them, keep in the freezer at -20°C.

Checklist

  1. Samples for DNA analysis have been collected according to the sampling protocol

  1. The Molecular testing form has been fully completed

  1. If applicable, the Parentage Information form has been fully completed

  1. The Owner details section has been fully completed

  1. The sample declaration and disclaimer has been read, understood and signed

  1. The fully completed form has been included in the consignment

  1. The consignment is properly packaged

  1. The samples are packaged to prevent damage/leakage

  1. The consignment is properly sealed for transport
  2. The consignment must be sent via a courier service or by personal delivery.