Request for epididymal sperm freezing | Paindaveine

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To be completed as soon as castration or euthanasia is decided, or just after death. The centre is notified as soon as this form is sent. Instructions for removing and transporting the testes are on the Semen freezing page.

The stallion

Name

UELN

Transponder number

Breed or studbook

Circumstances

The testes are removed

during castration

after death or euthanasia

Date and time (planned or actual)

Place (address)

Veterinarian removing the testes

Optional. If you give the veterinarian's email address, they will receive our removal instructions as soon as the request is signed.

Veterinarian's telephone

Veterinarian's email address

Remarks

Optional: recent treatments, cause of death…

Transport of the testes

The testes will be

brought by me

brought by another person

collected by transport arranged by the centre at my request

This person's name

Expected arrival at the centre

Use of the semen and tests

The semen will be used

in Belgium

in another European Union country (after castration only)

outside the European Union

Country of destination

I understand that, at the latest when the testes are removed, the veterinarian must take a blood sample for equine infectious anaemia testing (Coggins test or ELISA) and three swabs for contagious equine metritis (sheath, urethra, urethral fossa), placed in Amies charcoal transport medium and sent with the testes. Without these tests, the semen cannot be used, even in Belgium.

I understand that equine viral arteritis testing is also required (serum neutralisation, on the same blood sample) and, before any dispatch, a new series of tests (infectious anaemia, arteritis, metritis) on samples taken between 14 and 90 days after removal of the testes. The semen stays at the centre until the results are known. After death, these tests are impossible: the semen cannot be intended for another EU country.

I understand that the requirements depend on the country of destination and must be agreed with the centre before the testes are removed: a test that cannot be done afterwards may prevent export.

Invoicing

Account holder (name or company name)

Company or VAT number (if a company)

Address

Telephone

Email address

Signature

I have read and accept the general terms and conditions.

General terms and conditions

Signatory's full name

En cliquant sur « I sign », vous recevez un courriel pour confirmer votre signature. Le document n’est signé qu’après cette confirmation.