Sample label:_____________________________________Microchip-No.: ___________________________________________________________________

Sex: F M

Animal 3 (MANDATORY - please complete using capital letters)

Name: ___________________________________________________________________

Pedigree-No.: ___________________________________________________________________

Sample: swab blood card0,5 ml EDTA-blood

Breed: ___________________________________________________________________

Date of birth: _________________________________________

Coat colour: _________________________________________

Tatoo-No.: _________________________________________

Please note: Genetic tests for cats and horses can be found on their respective submission forms!

Submission form

Genetics Dog

_________________________________________________VAT-ID:

_______________________________________

_______________________________________

Tel.:

Street:

Zipcode/city:

Fax/email:

Name: _______________________________________

First name:

_______________________________________

_______________________________________

_______________________________________

Birthday _______________________________________(If the invoice should be sent to the owner or submitter, please include their complete address and signature )

Customer-No. / Barcode

Business Hours: Mo - Fr: 9:00 - 18:00 h, Sa: 9:00 - 13:00 h

Notification: MailFax Report copy to owneremail

_________________________________________________VAT-ID:

Clinic address:(stamp or block letters)

Fax/e-mail:_________________________________________________

Date/Signature_________________________________________________

Certificate 4,60 €

Owners address:(block letters only, please)

D000150030153DBeleg-ID

000150030153

Invoice to:

OwnerVeterinarian

Pedigree-No.: ___________________________________________________________________

Date of birth: _________________________________________

Coat colour: _________________________________________

Sample label:_____________________________________

Animal 2 (MANDATORY - please complete using capital letters)

Sample: 0,5 ml EDTA-blood swab blood card

Microchip-No.: ___________________________________________________________________

Sex: F M

Breed: ___________________________________________________________________

Name: ___________________________________________________________________

Tatoo-No.: _________________________________________

(owners signature for directinvoicing)

_________________________

Courier

Please note:Address for invoicing and signee must be identical

3) Certificates are included in the services of DNA-profile and parentage testing2) Certificates are not issued for partner laboratory services1) The identity of the animal needs to be confirmed by a veterinarian (specified by Microchip-No., Tattoo-No., Pedigree-No.)

Name:____________________________________________________-

Patient-ID:_________________________________________ Date of sampling: ______________________________________

I have checked the animals identity and assure that samples are taken from the animals mentioned below.

Signature / Stamp veterinarian:____________________________________________________-

Animal 1 (MANDATORY - please complete using capital letters)

Name: ___________________________________________________________________

Breed: ___________________________________________________________________

Pedigree-No.: ___________________________________________________________________

Microchip-No.: ___________________________________________________________________

Date of birth: _________________________________________

Coat colour: _________________________________________

Tatoo-No.: _________________________________________

Sample label:_____________________________________

Sample: 0,5 ml EDTA-blood swab blood card Sex: F M

Please note: Indication of breed is mandatory!

8105

Post box 1810 · 97668 Bad Kissingen /GermanyPhone 0049 (0)971/72020 fax 0049 (0)971/68546E-Mail: info@laboklin com

Hereditary Diseases (Sample Material: 0,5 - 1 ml EDTA-blood or 2x Buccal Swabs)

* Partnerlab

Musladin-Lueke Syndrome (MLS)

Hypomyelination / Shaking Puppy Syndrome (SPS)

Hereditary Cataract (HSF4)*

Glycogen Storage Disease Type II (GSDII, Pompe)

Factor VII Deficiency

(Chesapeake Bay Retriever)

Ectodermal Dysplasia/Skin Fragility Syndrome (ED/SFS)

(Irish Terrier, Kromfohrländer)Digital Hyperkeratosis (DH)

(Bernese Mountain Dog)Degenerative Myelopathy Exon 1

(Chinese Crested, Kerry Blue Terrier)Canine Multiple System Degeneration (CMSD)

(Australian Shepherd, Cane Corso, Coton de Tulear, Great Pyrenees, Lapponian Herder, Mastiff, Perro de Presa Canario)

Canine Multi-focal Retinopathy (CMR)* Optigen

(Lagotto Romagnolo)Juvenile Epilepsy

(German Shorthaired Pointer)Junctional Epidermolysis Bullosa (JEB)

(Beagle, Border Collie)Imerslund-Gräsbeck Syndrome (IGS)

(All breeds)Hyperuricosuria (SLC)

(Greyhound)

Hereditary Neuropathy (GHN)

(Labrador Retriever)Hereditary Nasal Parakeratosis (HNPK)

(Great Dane, Labrador Retriever)Hereditary Myopathy (CNM)

(Boston Terrier, French Bulldog, Staffordshire Bull Terrier)

(Australian Shepherd, Wäller)Hereditary Cataract (HSF4)

(Rhodesian Ridgeback)Hemophilia B (Factor IX deficiency)

(Bichon Havanese)Hemophilia A (Factor VIII deficiency)

Glycogen Storage Disease (GSDIIIa)

L-2-Hydroxyglutaric Aciduria (L-2-HGA)(Staffordshire Bull Terrier)

(Finnish Lapphund, Lapponian Herder, Swedish Lapphund)

(English Springer Spaniel, Samoyed)

Collie Eye Anomaly (CEA)* Optigen

Brachyuria(Breeds upon request)

(Australian Shepherd, Bearded Collie, Border Collie, Boykin Spaniel, Hokkaido, Lancashire Heeler, Longhaired Whippet, Nova Scotia Duck Tolling Retriever, Rough - Smooth Collie, Shetland Sheepdog)

Myotonia Congenita(Miniature Schnauzer)

Narcolepsy(Doberman Pinscher, Labrador Retriever)

(Standard Poodle)Neonatal Encephalopathy (NEWS)

Copper Toxicosis (CT)(Bedlington Terrier)

(All breeds)Degenerative Myelopathy (DM)

(Australien Cattle Dog, Labrador Retriever, Landseer, Newfoundland)

Cystinuria

(Beagle)

Congenital Hypothyroidism with Goiter (CHG)(Spanish Waterdog)

(Shorthaired - Wirehaired Dachshund)Osteogenesis imperfecta (Brittle Bone Disease)

(American Bulldog, American Staffordshire Terrier, Australian Shepherd, Border Collie, Dachshund, English Setter, Tibet Terrier)

Neuronal Ceroid Lipofuscinosis (NCL)

Myostation mutation ("Bully-Gen")

Night Blindness (CSNB)(Briard)

Exercise Induced Collapse (EIC)(Boykin Spaniel, Chesapeake Bay Retriever, Curly Coated Retriever, German Wirehaired Pointer, Labrador Retriever, Old English Sheepdog, Pembroke Welsh Corgi)

Familial Nephropathy (FN)*(English Cocker Spaniel)

Familial Nephropathy (FN)

Globoid Cell Leucodystrophy / Krabbe-disease

(English Springer Spaniel)

(Cairn Terrier, West Highland White Terrier)

(Curly Coated Retriever)

GM1-Gangliosidosis

(Cavalier King Charles Spaniel)

(Airedale Terrier, Alaskan Klee Kai, Beagle, Giant Schnauzer, Scottish Deerhound)

Episodic Falling (EF)(Cavalier King Charles Spaniel)

Muscular Dystrophy(Cavalier King Charles Spaniel, Golden Retriever)

Neonatal Cortical Cerebellar Abiotrophy (NCCD)(Beagle)

(Husky, Portuguese Waterdog, Shiba Inu)

Grey Collie Syndrome (Canine Cyclic Neutropenia)(Collie)

(Brasilian Terrier, German Shepherd)Mucopolysaccharidosis Type VII (MPS)

(Australian Shepherd, Border Collie, Elo, German Shepherd, Longhaired Whippet, McNab, Old English Sheepdog, Rough - Smooth Collie, Shetland Sheepdog, Silken Windhound, Wäller, White Shepherd)

MDR1 Gene Defect (Ivermectin Sensitivity)*

(All breeds)Malignant Hyperthermia (MH)

(Pug)Necrotizing Meningoencephalitis (PDE)

Dry Eye Curly Coat Syndrome (CCS)

Canine Leucocyte Adhesion Deficiency (CLAD)

Fucosidosis

(Irish Red and White Setter, Irish Setter)

(Whippet)

Late Onset Ataxia (LOA)(Parson Russell Terrier)

Please find test combinations for genetic diseases on page 4

(Weimaraner)

In order to allow breeding club discount for the owner please enclose a breeding club membership confirmation with each sample submission. The invoice cannot be altered subsequently.

D000000000001DBeleg-ID

000000000001

Dog

8411

8443

8576

8513

8151

8484

8472

8485

8575

8519

8459

8198

8475

8154

8179

8421

8073

8157

8221

8232

8156

8125

8120

8219

8022

8067

8155

8034

8158

8013

8434

8215

8075

8220

8011

8152

8131

8192

8007

8066

8202

8068

8457

8098

8069

8032

8062

8429

8406

8012

8016

8493

In order to allow breeding club discount for the owner please enclose a breeding club membership confirmation with each sample submission. The invoice cannot be altered subsequently.

* Partnerlab

(Czechoslovakian Wolfdog, German Shepherd, Saarloos Wolfdog)Dwarfism (Pituitary Form)

(Labrador Retriever)Dwarfism (Skeletal Dysplasia 2)

(Basset Hound, Landseer)Thrombopathia

(Border Collie)Trapped Neutrophil Syndrome (TNS)

(Newfoundland)Subvalvular Aortic Stenosis (SAS)

(Irish Wolfshound)Startle Disease

(Jack Russell Terrier, Parson Russell Terrier)Spinocerebellar Ataxia (SCA)

(Labrador Retriever, Samoyed)Retinal Dysplasia* (OSD) Optigen

(Basenji, Beagle, Labrador Retriever, Pug, Westhighland White Terrier)Pyruvate Kinase Deficiency (PK-Deficiency)

(Clumber - Sussex-Spaniel)

Pyruvat Dehydrogenase Phosphatase 1 Deficiency (PDP1)

(Soft-Coated Wheaten Terrier)Protein Losing Nephropathy (PLN)

(Beagle)Primary Open Angle Glaucoma (POAG)

Parson Russell Terrier, Patterdale Terrier, Rat Terrier, Sealyham Terrier, Tibet Terrier, Toy Fox Terrier, Volpino Italiano, Welsh Terrier, Westfalenterrier)

(Amerikan Eskimo Dog, American Hairless Terrier, Australian Cattle Dog, Chinese Crested, Chinese Foo Dog, Jagdterrier, Jack Russell Terrier, Lakeland Terrier, Lancashire Heeler, Lucas Terrier, Miniature Bull Terrier,

Primary Lens Luxation (PLL)

(Old English Sheepdog)Primary Ciliary Dyskinesia (PCD)

(Alaskan Malamute)Polyneuropathy (AMPN)

(Bull Terrier)Polycystic Kidney Disease (PKD)

(American Cocker Spaniel, English Springer Spaniel, German Spaniel, Whippet)

Phosphofructokinase Deficiency (PFKD)

Hereditary Diseases (Sample Material: 0,5 - 1 ml EDTA-blood or 2x Buccal Swabs)

Please find test combinations for genetic diseases on page 4

XL-PRA* Optigen

(Papillon, Phalène)Pap_PRA1

Bas_PRA(Basenji)

Progressive Retinal Atrophy (Sample Material: 0,5 - 1 ml EDTA-blood or 2x Buccal Swabs)

rcd 4-PRA(Australian Cattle Dog, English Setter, Gordon Setter, Irish Setter, KleinerMünsterländer, Polski Owczarek Nizinny, Tibet Terrier)

(Samoyed, Sibirian Husky)

Dominant Form of PRA(Bull Mastiff, English Mastiff)

Generalized PRA(Schapendoes)

GR_PRA1(Golden Retriever)

prcd-PRAperformed by Optigen*performed by partnerlab*

(Irish Setter, Irish Red and White Setter)

rcd 1a-PRA(Sloughi)

(Collie)

(Welsh Corgi)rcd 3-PRA

rcd 2-PRA* Optigen

rcd 1-PRA

crd-PRA(Standard Wirehaired Dachshund)

Typ A-PRA* Optigen(Miniature Schnauzer)

(American Cocker Spaniel, American Eskimo Dog, Australian Cattle Dog, Australian Shepherd, Australian Stumpy Tail Cattle Dog, Chesapeake Bay Retrivier, Chinese Crested, Cockapoo, Dwarf Poodle, English CockerSpaniel,Entlubicher Mountaindog, Finnish Lapphund, Golden Retriever, Kuvasz, Lapponian Herder, Labrador Retriever, Markiesje, Nova Scotia Duck Tolling Retriever, Norwegian Elkhound, Poodle, Portuguese Waterdog, Swedish Lapphund, Toy Poodle,

Spanish Water Dog, Silky Terrier, Yorkshire Terrier)

D000000000002DBeleg-ID

000000000002

von-Willebrand Disease

von-Willebrand Disease (Sample Material: 0,5 - 1 ml EDTA-blood or 2x Buccal Swabs)

(Scotch Terrier, Sheltie)von-Willebrand Disease Type 3

(German Shorthaired Pointer, German Wirehaired Pointer)

von-Willebrand Disease Type 2

(Bernese Mountain Dog, Coton de Tulear, Doberman, Drentsche Patrijshond, German Pinscher, Labradoodle, Manchester Terrier, Kerry Blue Terrier, Papillon, Pembroke Welsh Corgi, Poodle, Stabyhound)

von-Willebrand Disease Type 1

(Dutch Kooiker)

8142

8456

8486

8143

8471

8191

8537

8150

8015

8104

8492

8452

8226

8483

8479

8476

8017

8445

8573

8574

8435

8042

8451

8200

8094

8127

8042

8042

8153

8042

8135

8444

8210

8233

8014

8119

D000000000003DBeleg-ID

000000000003

General terms and conditions:

GB - 015.003 14/07Complete general terms and conditions of business see www.laboklin.com

Breeding club discount only available if the invoice is sent to the owner!

Prices in Euro excl. VAT / Services offered and prices may be subject to change / Charge is x 1.3 if invoice is sent to owner (exception: combination tests and parnterlabs)

Supply order:Submission forms - GENETICS - DOG

Barcodes

Faeces Containers

Histology Containers with formalin

Submission forms - GENETICS - EQUINE Submission forms - FARM ANIMAL

Envelopes Cytobrushes (DNA-tests)

Submission forms - GENERALContainers for Tubes

Slide Containers

Swabs (without Medium)Heparin Tubes

Submission forms - HYGIENE

NaFI-Tubes

Urine containers

EDTA Tubes

Submission forms - ALLERGY

Submission forms - EQUINE

Swabs (with Medium)

Submission forms - PATHOLOGYMedium for Chlamydophila-Ag

Tubes (blood/serum)

Citrate Tubes

Containers for Swabs

Submission forms - GENETICS - CAT

Coat Colours / Coat Length (Breeds upon request) (Sample Material: 0,5 - 1 ml EDTA-blood or 2x Buccal Swabs)

EM-Locus (Melanistic Mask Allele)

(English Cocker Spaniel)EH-Locus (sable)

Furnishing

(Please note: the allele kbr for brindle cannot be determined using this test)

(Chinese Crested, Mexican Hairless Dog, Peruvian Hairless Dog)Hairlessness

S-Locus*(Breeds upon requst)

EG-Locus (domino, grizzle)(Afghan Hound, Saluki)

(Portuguese Waterdog)Improper Coat

K-Locus (only the alleles KB + ky)

A-Locus (agouti)

D-Locus (dilution)

B-Locus (brown, chocolate)

E-Locus (yellow, lemon, red, cream, apricot)

Coat Length

Curly

In order to allow breeding club discount for the owner please enclose a breeding club membership confirmation with each sample submission. The invoice cannot be altered subsequently.

Cardholders name:______________________________________________________________

For accepting credit card we charge EUR 4,95 plus VAT.

Credit card Visa Mastercard

Total amount:________________________________________________________________

Credit card No.:________________________________________________________________

Cardholders signature: _________________________________________

Exp. date:____________________________________________________

Invoice-No.:____________________________________________________

(Jack Russell Terrier, Parson Russell Terrier)Late Onset Ataxia (LOA) + Spinocerebellar Ataxia (SCA)

(Lagotto Romagnolo)

(Cavalier King Charles Spaniel)Dry Eye Curly Coat Syndrome (CCS) + Episodic Falling (EF)

(Bernese Mountain Dog)Degenerative Myelopathy (DM) Exon1 + Exon2

Juvenile Epilepsy (JE) + Furnishing

(Jack Russell Terrier, Parson Russell Terrier)Late Onset Ataxia (LOA) + Spinocerebellar Ataxia (SCA) + Primary Lens Luxation (PLL)

Hereditary Diseases (Sample Material: 0,5 - 1 ml EDTA-blood or 2x Buccal Swabs)

Test combinations

* Partnerlab

DNA-Profiling ISAG 2006 (Sample Material: 0,5 - 1 ml EDTA-blood)

A DNA profile is necessary for each parent for parentage verification. If only one parent is available, this should bediscussed prior to sample submission.

Please note: The person collecting the sample should be officially designated or appointed.DNA profile (genetic fingerprint)

Parentage verification (paternity test)

Likelihood ratio calculation (Analysis of blood relationship)

Breed analysis (Database analysis)Please note: The test can only determine breeds found in our database. Additional information is available at www.laboklin.com or by calling us.

Please note: The test is only possible for specific breeds. Additional information is available at www.laboklin.com or by calling us.

64

80

5

14

97

94

10 55

5611

12

6a3a

40

4

7

3

57

16

6

5813

1

2

6b

8146

8180

8195

8599

8438

8458

8405

8145

8144

8136

8023

8018

8124

8196

8570

8407

8447

8590

8571

8107

8109

8212

8211