ARF (Version 1, 2017)

AQUACULTURE FARM REGISTRATION FORM

* Tick Ö where appropriate

Categories : Food Fish Farm Hatchery Cage Culture Ornamental Fish Farm Importer

Exporter Transporter Others………………………………..

A Company/ Farm Information

1 Manager's Name :

2 IC Number :

3 Phone No. : 4 Fax No. :

5 Handphone No. :

6 E-mail Address :

7 Correspondent Address :

8 Biosecurity Manager :

9 IC Number :

10 Phone No. : 11 Fax No. :

12 Handphone No. :

13 E-mail Address :

14 Company/ Farm Name and Address :

15 Company/ Farm Area (ha)

16 Land Status : Free Hold Lease Hold TOL Others :

17 Company/ Farm Location (entrance point/ office) : Latitude : Longitude :

Note:
18 Applicant shall submit documents as listed below:
a) Company/ Farm Information
i) Company registration certificate (ROC)
ii) Land Tittle Document
iii) Company/ Farm organisational chart
iv) No. of workers (all levels)
vi) No. of Broodstock
vii) License export & import(LKIM)

b) List of Raw Material and Supplier

i) Broodstock Source
ii) Fry
iii) Feed (Single feed, pelleted and live feed)
iv) Veterinary Drugs
v) Chemical
vi) Others (please specify):
c) Company/ Farm layout including:
i) Company/ Premise Location
ii) Layout detail/ premis plan
iii) Water Supplier Source (water inlet/outlet)
iv) Hygiene facilities
d) Production and Marketing
ii) List of Buyer with fish spesies name (scientific and common)
iii) List of Supplier with fish spesies name (scientific and common)

e) Transportation
i) Type of vehicle
ii) Registration Number

Page 1 of 2
 ARF (Version 1, 2017)

B Company / Farm / Premis Information

Please tick (Ö) and complete the information

1 Company/ Farm / Premis Facilities:

Number
System Total Area (m²)
Reservoir Broodstock Breeding Nursery Grow out Treatment Quarantine
a Earth pond (ha)
b Concrete pond (m2)
c Cement tank (m2)
d Fibreglass tank (m2)
e Aquarium (m2)
f Canvas (m2)
g Cage (m2)
h Others :

2 Water source : (a) Sea water (d) Domestic Water

(b) Mining Pool (e) Under ground water
(c) River f) Others (specify)……………………………………………

3 Discharge Water Treatment (a) Treated

(b) Untreated

4 Water Treatment Method UV Light/ Ozone Chemical (specify)…………………….. Other (specify)…………………………..

5 Intended Use of fish : Export Import Domestic Domestic Sabah/ Sarawak/ Labuan

6 Main species cultured/ No. Scientific Name Common Name Montly (mt) Yearly (mt)
and production i
estimation: ii
iii
iv
v
*Please attach additional information if necessary

Declaration by Applicant :

I hereby declare that all information given above are true.

Applicant Signature :

Date : Company Stamp :

Fill by State Fisheries Biosecurity Unit:

Aquaculture Farm / Hatchery /Cage culture / Ornamental fish farm / Importer / Exporter / Transporter recommended / not recommended to be registered

Signature :
Remarks:
Officer Name :

Date : Official Stamp :

Fill by Fisheries Biosecurity Division:

Approved for registration Registration No. :

Signature :

Officer Name :

Date : Official Stamp :

Page 2 of 2