Johne’s Disease Calf Accreditation Program (JDCAP)

JDCAP CLAIM FORMI

Your details (Please print in block letters)

Name of ClaimantProperty Identification Code (PIC)

Phone number

Address towhich chequeis to be posted

ABN:

(If you don’t provide an ABN number, 48.5% PAYG withholding applies)

Date Number Full particulars Rate Amount1 JDCAP Initial Entry (GST Inclusive) $356

1 JDCAP Renewal (GST Inclusive) $250

Total $

Signature of Claimant: Date …/…/….

For office Use Only

Charge code

Entity Account Cost Centre Authority Project Output Identifier Amount ($) c(1) (5) (3) (4) (4) (4) (8)

S 86540 742 4025 0664 2025 00801211

Please submit your completed claim form, copy of the veterinary practice invoice/receipt and JDCAP certificate to:Mail: JDCAP Admin Officer

Agriculture Victoria (DEDJTR)

PO BOX 2500

BENDIGO VIC 3554

Email: vet.services@ecodev.vic.gov.au

Fax: 03 5430 4520

iVersion: 31 October 2017 F9-11