/ Application for a Licence to Import Live Ornamental Fish into St Helena
VETERINARY SECTION / Form issued pursuant to Regulation 3 of the St Helena Animal (Diseases) Regulations, 2001 (as amended).
Please complete this form in BLOCK LETTERS
In order for ANRD to provide an import licence of this type, applications should be made no later than 1 working weeks before the scheduled date that the animal(s) is/are expected to leave the exporting country.THIS IS AN APPLICATION NOT A LICENCE / FOR ANRD USE:
Issued on: ______
Date received: ______
Licence No: ______

Importer Details (address in St Helena)

Your Name / Contact person
Full Address
Work phone / Email / Fax

Fish Supplier (in exporting country)

Name of Business / Contact person
Full Address
Work phone / Email / Fax

Application for a Licence to Import Live Ornamental Fish into St Helena

Description of Fish
1 Species - common name / 2 Species - scientific name / 3 Description / 4 Wild caught or captive bred / Number of fish

Notes:

1 For example: guppy, molly, sarassa comet, shubunkin.

2 The Latin taxonomic name, for example: Hypostomus plecostomus .

3 For example: fantail, albino, black.

4 Taken from the wild or bred in captivity. Write ‘WILD’ or ‘CAPTIVE’.

Country of Origin / Date of Importation
Importer’s Declaration
I the undersigned hereby declare that the information provided above is accurate to the best of my knowledge, and understand that if a ‘Licence to Import’ document is issued, I must comply in full with the conditions attached to such a licence. I also understand that on importation, should the fish show any signs of contagious disease, they may be seized and humanely destroyed.

WHERE TO SEND THIS APPLICATION WHEN IT IS COMPLETED

Post, e-mail, or fax
Senior Veterinary Officer / Fax: +00 290 24603
Agriculture and Natural Resources Division, Scotland, St Helena Island, STHL 1ZZ / E-mail:
Signature: Date:
Name (in capitals):
I, the

Notes:

(1)  This form contains 2 pages. Applicants should ensure that the sheets and any supporting documentation are stapled and clipped together when submitted. ANRD will not accept applications comprising incomplete forms.

(2)  The data collected in this form will be kept in confidence. They may however be disclosed to other third parties on the Island, if such disclosure is necessary to facilitate consideration of the related application, or is in the public interest.

(3)  There may be fewer fish brought in than applied for, but not more.