Premium Member Form Service Providers

Premium Membership Application for Service Providers

YOUR REGISTER TO PARTICIPATE IN THE NATIONAL BIOSECURITY STANDARDS AND VALUE CHAIN.

Name & Surname (Applicant)

Position

SA ID Number

Company Name

Company Reg No

VAT

Farm Name and Address

Contact Number

Herd Veterinarian Name & Surname

Herd Veterinarian Practice Name

Herd Veterinarian Contact Number

Premium Member Participation Fee

[ANNUAL FEE PER PRODUCTION UNIT /FARM] The participation fee is R4999.00 [excl vat] per production unit per 12 month period thereafter: Membership will be registered on receipt of payment. Arrangement for monthly debit order payments may be requested. [To be billed on receipt of this application]

Declaration

He/she is solely responsible for all information provided for recording on the BIOSEK register and platform for herd marketing purposes. Information is provided unconditionally for recording on the Biosek platform and register. DISCLAIMER Biosek [including and its employees and service providers assumes no responsibility or liability for any errors or omissions in the information supplied by members for recording on the V-PLAN register and platform. The information contained in or on the Biosek site is provided on an "as is" basis at the sole discretion of the member providing the information and Biosek does not guarantee completeness, accuracy or timeliness supplied.

Premium Membership Application for Service Providers

Address

Contact

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