Part I: Details of dispatched consignment

EUROPEAN UNION

Commercial document

I.1. Consignor

Name

Address

Postcode

I.2. Document reference No

I.2.a. Local reference No

I.3. Central competent authority

I.4. Local competent authority

I.5. Consignee

Name

Address

Postcode

Tel.

I.6.

I.7.

I.8. Country of origin

ISO code

I.9. Region of origin

Code

I.10. Country of destination

ISO code

I.11. Region of destination

Code

I.12. Place of origin

Establishment

Name

Approval number

Address

Postcode

I.13. Place of destiantion

Establishment

Other

Name

Approval number

Address

Postcode

I.14. Place of loading

I.15. Date of departure

I.16. Means of transport

Aeroplane

Ship

Railway wagon

Road vehicle

Other

Identification

I.17. Transporter

Name

Approval number

Address

Postcode

Member State

I.18. Description of commodity

I.19. Commodity code (CN code)

I.20. Quantity

I.21. Temperature of product

Ambient

Chilled

Frozen

Controlled temperature

I.22. Number of packages

I.23. Seal/Container No

I.24. Type of packaging

I.25. Commodities certified for:

Animal feedingstuff

Technical use

I.26.

I.27. Transit through Member States

Member State

ISO Code

Member State

ISO Code

Member State

ISO Code

I.28. Export

Third country

ISO Code

Exit point

Code

I.29.

I.30.

I.31. Identification of the commodities

Approval number of establishments

Species

(scientific name)

Nature of commodity

Category

Treatment type

Manufacturing plant

Batch number

Part II: Certification

COUNTRY

Animal by-products/derived products not intended for human consumption

II. Health information

II.a. Certificate reference number

II.b.

II.1. Declaration by the consignor

I, the undersigned, declare that:

II.1.1. the information in Part I is factually correct;

II.1.2. all precautions have been taken to avoid contamination of the animal by-products or derived products with pathogenic agents and cross-contamination between various categories.

Notes:

Part I:

Box reference I.9 and I.11: if appropriate.

Box reference I.12, I.13 and I.17: approval number or registration number. In the case of processed manure indicate in Box I.13 the approval or registration number of plant or holding of destination.

Box reference I.14: complete if different from ‘I.1. Consignor’.

Box reference I.25: technical use: any use other than for animal consumption.

Box reference I.31:

Animal species: For Category 3 material and products derived therefrom destined for use as feed material. Select from the following: Aves, Ruminants, Non-Ruminants, Mammalia, Pesca, Mollusca, Crustacea, Invertebrates.

Nature of commodity: Enter a commodity chosen from the following list: ‘apiculture by-products’, ‘blood products’, ‘blood’, ‘bloodmeal’, ‘digestion residues’, ‘digestive tract content’, ‘dog-chews’, ‘fishmeal’, ‘flavouring innards’, ‘gelatine’, ‘greaves’, ‘hides and skins’, ‘hydrolysed proteins’, ‘organic fertilisers’, ‘pet food’, ‘processed animal protein’, ‘processed pet food’, ‘raw pet food’, ‘rendered fats’, ‘compost’, ‘processed manure’, ‘fish oil’, ‘milk products’, ‘centrifuge or separator sludge from milk processing’, ‘dicalciumphosphate’, ‘tricalciumphosphate’, ‘collagen’, ‘egg products’, ‘serum of equidae’, ‘game trophies’, ‘wool’, ‘hair’, ‘pig bristles’, ‘feathers’, ‘animal by-products for processing’, ‘derived products’.

Category: Specify Category 1, 2 or 3 materials.

In case of Category 3 material, indicate the point of Article 10 of Regulation (EC) No 1069/2009 that refers to the animal by-product concerned (e.g. Article 10(a), Article 10(b), etc.).

In the case of Category 3 material for use in raw petfood indicate ‘3a’, ’3b(i)‘ or ‘3b(ii)’ depending on whether the animal by-products are referred to in Article 10(a) or in Article 10(b)(i) or (ii) of Regulation (EC) No 1069/2009.

In the case of hides and skins and products derived therefrom, indicate ‘3b(iii)’ or ‘3(n)’ depending on whether the animal by-products or derived products are referred to in Article 10(b)(iii) or in Article 10(n) of Regulation (EC) No 1069/2009.

Where the consignment is made of more than one category, indicate the quantity and if applicable the number of containers per category of materials.

Treatment type: For treated hides and skins indicate the treatment:

‘(a)’ for dried;

‘(b)’ for dry-salted or wet-salted for at least 14 days prior to dispatch;

‘(c)’ for salted for seven days in sea salt with the addition of 2 % sodium carbonate.

For Categories 1 and 2 materials describe the method of processing or transformation. Indicate the relevant processing method (choose a method from 1 to 5 referred to in Chapter III of Annex IV to Regulation (EU) No 142/2011).

For Category 3 materials and derived products from Category 3 material destined for use in feed: if appropriate describe the nature and the methods of the treatment. Indicate the relevant processing method (choose a method from 1 to 7 referred to in Chapter III of Annex IV to Regulation (EU) No 142/2011).

Batch number: Enter batch number or ear tag number, if applicable.

Part II:

The signature must be in a different colour to that of the printing.

Signature

Done at … on …

(place)

(date)

(signature of the responsible person/consignor)

(name, in capital letters)’

PAGE 1/2

APPLICATION FOR THE AUTHORISATION OF THE DISPATCH OF ANIMAL BY-PRODUCTS AND DERIVED PRODUCTS TO ANOTHER MEMBER STATE

(ARTICLE 48 OF REGULATION (EC) No 1069/2009)

Name and address of place of origin

Approval or registration number, issued by (competent authority)

Name and address of consignor

Approval or registration number, issued by (competent authority)

Name and address of applicant

Approval or registration number, issued by (competent authority)

Name and address of place of destination

Approval or registration number, issued by (competent authority)

Animal by-products/derived products (1)

Category 1 material consisting of:

(nature of the material)

Category 2 material consisting of:

(nature of the material)

Meat-and-bone meal derived from Category 1 material

Animal fat derived from Category 1 material

Meat-and-bone meal derived from Category 2 material

Animal fat derived from Category 2 material

Intended use (1)

Disposal

Processing

Combustion

Application to land

Transformation into biogas

Composting

Petfood (2)

Production of biodiesel

For feeding to (3):

For the manufacture of the following derived products (4):

Indicate the quantity of animal by-products/derived products (volume or mass) (4) (5)

PAGE 2/2

(APPLICATION FOR THE AUTHORISATION OF THE DISPATCH OFANIMAL BY-PRODUCTS AND DERIVED PRODUCTS TO ANOTHER MEMBER STATE

(ARTICLE 48 OF REGULATION (EC) No 1069/2009))

In case of meat-and-bone meal and animal fat:

The materials have been processed according to the following method (6): …

Species of origin:

I, the undersigned, declare that the above information is factually correct.

(Signature: name, date, contact details: telephone, fax (if applicable), e-mail)

Decision by the competent authority of the Member State of destination (7):

The dispatch of the consignment is:

refused.

accepted.

accepted subject to the application of pressure sterilisation (method 1) to the materials.

accepted subject to the following conditions for the dispatch (4): …

This authorisation is valid until: … (8)

(Date, stamp and signature of the competent authority)

Notes:

Complete the document in BLOCK capitals.

(1) Tick as appropriate.

(2) In the case of petfood produced with Category 1 material comprising animal by-products derived from animals which have been submitted to illegal treatment as defined in Article 1(2)(d) of Directive 96/22/EC or Article 2(b) of Directive 96/23/EC.

(3) Specify in accordance with Article 18 of Regulation (EC) No 1069/2009.

(4) Fill in, if appropriate.

(5) Specify.

(6) Specify one of the processing methods referred to in Chapter III of Annex IV to Regulation (EU) No 142/2011.

(7) For the competent authority: tick as appropriate.

(8) Insert date of expiration of authorisation.’