Deoxynivalenol (DON) if applicable    __________       ___________
Combinable Crops Passport (version 01/11) Issued Jan 2011
Section 1: Grain Movement Declaration (to be completed by the grower/storekeeper)
Crop Type
Loading Date
Vehicle Reg No.
Variety (if applicable)
Harvest Year (if applicable)
Store/Bin No./Name (if applicable)
Haulier Company Name
Trailer/ID No.
Fixing No.
Section 2: Vehicle Hygiene (to be completed by the haulier)
Date
 C.   (For grain drawn from bulk store). The crop carried in the vehicle referred to above has been drawn from a bulk, delivered by suppliers who         declared it had been partly/entirely treated with post-harvest treatments at or below the recommended levels stated by the manufacturer. 
Product
Tick Cleansing Method
1st Load (most recent)
2nd Load
3rd Load
Section 3: Inspection of Vehicle Statement
 "We have visually inspected this vehicle prior to loading and believe it to be in a fit condition to carry grain or other combinable crops to enter into the food or feed chain. No tests have been carried out to establish this and no warranty is given by this declaration" .
Section 4: Post-Harvest Treatment - where applicable (to be completed by grower/storekeeper)
Please circle sections A B or C as appropriate and insert date and product details in the space provided
A.  No post-harvest treatment has been applied to the crop carried in the vehicle referred to above.
B.  Post-harvest applications of pesticide and/or other treatments, at or below the recommended level as stated by the manufacturer, have been made to the crop carried in the vehicle referred to above. For malting barley, only treatments permitted on the British beer and pub Association Approved List have been used.
Date:						Product:  
Section 5: Fusarium Mycotoxins - All Cereals
(to be completed by grower/storekeeper)
A risk assessment for DON(wheat only) was carried out and produced the following result (insert value)
Section 6: Confirmation (to be completed by growers/storekeeper confirming sections 1,3,4 & 5 and by the haulier confirming sections 2 & 3)
Mycotoxin test(s), where applicable, have been carried out producing the following result:  
ZON result if applicable                __________       ___________
If more than one test has been carried out, please record all results.
Note: A signature on behalf of the grower/storekeeper and haulier is required to complete the form
Grower/Storekeeper

Print Name  ___________________________
Position  ___________________________
Haulier
Signed (Driver)  ___________________________
Print Name  ___________________________
Risk assessment details can be found at www.hgca.com or wwwassuredcrops.co.uk
Section 7: GM Statement (oil seed crops only)
In compliance with the regulations EC 1829/2003 and EC 1830/2003, the crop covered by this declaration is NOT subject to the labelling requirements specified in the above mentioned regulations and necessary steps have been taken to preserve the conventional (i.e. non-GM) status of the crop.
Section 9: Receipt Details (to be completed by the receiver)
Receiver's Ref:										Weighbridge Ticket No:
Received by:											Date of Delivery:
Brush/Vac
Wash
Steam Clean
Disinfect
None
Date of Test
Result (ppb)

Section 8: Renewable Energy (confirmation to be completed by grower/storekeeper)
Signed:
Print Name:
Business Name :   
Collection Address :      
Post Code :    
DON Risk Assessment
Signed ___________________________
Members Ref :

  

  

          

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