Trade in Endangered Species Act 1989 Application for a permit or certificate to export, re-export, import, or introduce specimens of animals or plants or derivatives thereof, subject to the Act. Important notes Incomplete applications will result in delays in processing. If you need help completing the application, please phone, fax or email the Department of Conservation at the numbers shown on the last page. The Trade in Endangered Species (TIES) Act provides for penalties for knowingly making false or misleading statements in this application. Many transactions relating to wildlife and wildlife products may require clearance from the Ministry of Agriculture and Forestry (MAF). Please contact MAF for information on export and quarantine controls. Please allow up to 20 working days for applications to be processed after receipt. Fee payable A fee of $40 is payable for an application permit. Please make cheques payable to the Department of Conservation. Permits will not be issued without payment being received. Supporting Documentation Please ensure that you attach (if applicable): Overseas CITES Export permit (in the case of CITES import application). A copy of the Department of Conservation import permit or other proof of legal import into New Zealand (for re-exports only). Type of Activity Please tick one only Import Export Re-export (complete re-export section) Re-exports Complete this section only if you intend to re-export specimens which have previously been imported to New Zealand. Was the specimen legally imported into New Zealand If yes, please attach proof of legal import (e.g. copy of Department of Conservation import permit). of Origin Issuing Authority Permit/certificate number Date of issue Please ensure that you attach a copy of the Department of Conservation import permit or other proof of legal import into New Zealand. OFFICE USE ONLY Date received Permit number Security identification 1
EXPORTER / RE-EXPORTER IMPORTER Name First given name(s) Name First given name(s) Family name (Surname) Family name (Surname) Organisation name (if appropriate) Organisation name (if appropriate) Postal address Postal address Street address If same as postal address, tick here Street address If same as postal address, tick here Contact details (including area code) Telephone number work Contact details (including area code) Telephone number work Telephone number home / mobile Telephone number home / mobile Fax number Fax number Email address Email address 2
PERMIT DETAILS What is the purpose of the export or import? (please tick one) Commercial Personal items that will not be traded Educational Hunting trophies Scientific exchange Travelling zoo or exhibition Scientific Transfer Specimen(s) Label numbers Travelling Zoo or Exhibition Specimen(s) Date acquired Please attach supporting documents SPECIMEN IDENTIFICATION The next page has boxes to enter the details of four specimens. If you have more than five specimens, you will need to photocopy the page before entering the details. NOTES ON HOW TO ENTER THE SPECIMEN DETAILS Note 1: Scientific name (Latin name) Two names, genus and species nomenclature must always be used. Note 2: Common name As known in New Zealand or the country of export is to be used. Note 3: Specimen description Such as live animals, live plants, flowers, ivory carvings, bone, etc, should be entered. Where possible, identifying marks and numbers such as tags for fur and hides, should be noted. Note 4: Quantity or unit Actual number, weight or volume. The unit must not refer to a number of boxes, bales or other generalised category. Note 5: Source codes SHIPMENT DETAILS (if known) Date of proposed export or import Date Month Year W R A C O U Specimens taken from the wild Specimens originating in a ranching operation Plants that are artificially propagated Animals bred in captivity Pre-convention specimens (prior to 1989 in New Zealand) Source unknown (must be justified) How will the shipment be sent? Please tick one only Air Sea Post Accompanied baggage Note 6: Number of containers Such as packages, crates, cartons, etc, to be used to ship the specimens should be noted. Note 7: Live or not live Should be entered as applicable. Consignment Details Accurate shipping details must be provided for all export consignments of live specimens. Applications may still be lodged for processing if these details are not known by the applicant at the time, but approval of the application and issue of the export or re-export permit will be conditional upon the CITES officer being advised not less than 24 hours prior to despatch, of the full shipping details. 3
Refer to notes on previous page before entering details. 4
Contacts Auckland Conservancy Office Private Bag 68908 Newton AUCKLAND Phone: (09) 307 9279 Fax: (09) 377 2919 Poneke Area Office PO Box 5086 WELLINGTON Phone: (04) 472 5821 Fax: (04) 499 0077 Canterbury Conservancy Office Private Bag 4715 CHRISTCHURCH Phone: (03) 379 9758 Fax: (03) 365 1388 Terrestrial Conservation Unit PO Box 10420 WELLINGTON Phone: (04) 471 0726 Fax: (04) 471 1082 Is a courier service required? No, go to next question Yes, please enclose a pre-paid courier bag Please check the following before signing the declaration: Enclosed a fee of $40 for the processing of this permit. Declaration I declare that: the particulars provided by me in this application are true and correct in every detail; and in the case of live animals, that they will be prepared and shipped in accordance with the current edition of the: IATA (International Air Transport Association) Live Animals regulations ; and in the case where the specimen is for personal use it will not be used for commercial purposes including sale, lease, hire or exchange and shall remain as my personal property. Name of applicant Signature of applicant Date signed by applicant Where the application is making an application on behalf of an incorporated company or other incorporated body the application shall state the capacity in which he/she is making the application (e.g. secretary, director). I hereby declare that the information in this application for a permit under the Trade in Endangered Species Act 1989 is true and correct and I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957. DECLARED at Date You have attached all relevant authorities and consents from the government of other countries that entitle you to import or export wildlife across their respective borders. You have attached any relevant documents listed on Page 1. A Justice of the Peace or a Solicitor of the High Court (or other person authorised to take a statutory declaration). I make this application in my capacity as of (name of Company or other incorporated body) Name of Justice of the Peace/Solicitor Authorising signature/stamp 5