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STATENE PARK

R & M Hanna Pty Ltd ABN 57 089 769 120

Print and send to 80 Scotchmans Road, Bellarine 3221

COVERING CERTIFICATE for SHIRAZ BLACK
Oldenberg, Germany  LM 43333-01553-03 and AWHA     Fresh or Frozen Semen

In order to ensure that your foal is eligible for registration with the AWHA (http://www.awha.com.au/) this form must accompany your booking form/contract and be accurately filled in with all of the relevant details.  Check the AWHA web site for breeding guidelines and registration requirements.  Not all mares will have a pedigree which meets the AWHA  requirements to produce a registered foal.  It is the mare owners responsibility to understand the AWHA rules.

MARE NAME: ______________________________________________________________DATE OF BIRTH: ______________________________

REGISTRY and NO: ________________________________________________________   MICROCHIP NO:   _____________________________

SIRE: _______________________________________   REGISTRY and NO: ________________________________________________________

DAM:_______________________________________    REGISTRY and NO: ________________________________________________________

COLOR:_______________________MARKINGS: ______________________________________________________________________________

BRANDS:   NEAR  ____________________________    OFF _______________________________   THIGH ______________________________

The diagrams must be sufficiently detailed to ensure the positive identification of the animal. White markings must be shown in red. If there are no markings, this fact must be stated. All head and neck whorls should be marked (X). Other whorls should be similarly recorded in greys and in animals lacking sufficient other distinguishing marks. Acquired marks and other distinguishing marks eg prophet’s thumb mark, wall eye etc should always be noted.         

I confirm that the information included on this form is accurate and correct.

SIGNATURE OF MARE OWNER:      __________________________________________________________DATE: ________________________

STREET ADDRESS  _____________________________________________________________________________________________________

CITY_________________________________________________STATE__________________POSTCODE_______________________________

TELEPHONE___________________________     MOBILE/S  ____________________________________________________________________

E-MAIL ADDRESS ______________________________________________________________________________________
 

Please print (2 Pages) and complete forms and send with all fees to Statene Park.