Microchip Number/Barcode ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Pet’s Name __________________________________

Species (e.g. Dog/Cat) ___________________ Breed/s _________________________________________ Date of Birth ___ ___ / ___ ___ / ___ ___

Primary Colour/s ____________________________________ Male Female Desexed: Yes No

Local council (at Pet’s Address) ________________________________________________________________________________________________

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CURRENT REGISTERED OWNER DETAILS (as recorded on file) I hereby relinquish ownership of the above animal to the new owner as below. If joint ownership, BOTH signatures are required on the form.

Full Legal Name/s _______________________________________________ Breeder/Supply Number ____________________________________

Signature/s _________________________________________________________________________________ Date ___ ___ / ___ ___ / ___ ___ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

NEW OWNER DETAILS

Full Legal Name/s (as per License/ID Card) _______________________________________________________________________________________

Email Address (confirmation sent via email) _______________________________________________________________________________________

Mobile Phone ___ ___ ___ ___ - ___ ___ ___ - ___ ___ ___ Alternate Phone ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___

Full Residential Address (Cannot be a PO Box Address) ______________________________________________________________________________

Suburb __________________________________________________ State _________________________ Postcode ________________________

Alternative Contact’s Full Legal Name ____________________________________ Mobile Phone ___ ___ ___ ___ - ___ ___ ___ - ___ ___ ___

Signature of New Owner/s _____________________________________________________________________ Date ___ ___ / ___ ___ / ___ ___

If you do not wish your information to be released to authorised persons for the purpose of returning your pet, please check this box. IMPORTANT: By checking this box, your information will not be provided to Vet’s and Councils and there is a risk your pet will not be returned to you, if found.

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PAYMENT DETAILS SUMMARY

Payment Details Visa MasterCard Please call me on Ph ___ ___ ___ ___ - ___ ___ ___ - ___ ___ ___ for payment

Money Order Cheque made out to Global Micro Animal Registry

Card number ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ Expiry date ___ ___ / ___ ___ CCV ___ ___ ___

Name on Card ________________________________________ Signature ___________________________________________________________

PLEASE NOTE: If the Current Registered Owner is not able to Sign this form or is not contactable, a Signed Statutory Declaration (available from our website) is also required to accompany this form. This process may also incur additional processing time dependant on the relevant state legislation.

Change of Ownership Form

PET DETAILS

Price subject to change without notification

feel free to use your pet’s new name.

I have another pet registered with GMAR.

...for Peace of MindAN IMA L REG I S T RYGLOBAL MICRO

By submitting this registration, I, as the above pet’s new owner, declare that my details provided on this form are true and correct. I confirm that I have Read, Understood and Accept Global Micro Animal Registry’s Terms & Conditions and Privacy Policy (which can be found at https:\\www.globalmicro.com.au) and confirm that I give permission for my contact details to be made available to any authorised person who can help with the recovery of my pet as per relevant state legislation. I also consent to receive information and promotions relevant to my pet and to joining the Global Micro Spotter Network, all of which I can unsubscribe via logging in to the Global Micro website after activating my account.

PLEASE NOTE: Under no circumstances will a Change of Ownership be processed over the phone. Forms can be emailed, faxed or posted to Global Micro Animal Registry as per the following:

PO Box 471 Hurstville NSW 1481 Ph: 02 8338 9063 Fax: 02 8338 8690 Email: contact@globalmicro.com.au

Total Amount $ ________________

Global Micro Change of Ownership - $10.00 Global Micro Pet Tag – One for $10.00

Global Micro Pet Tag Our QR Coded Pet Tag includes the ability for the finder of your pet to send you an SMS and Email in real time, all whilst protecting your privacy.