Part I : Details of consignment presented

EUROPEAN UNION

Intra trade certificate

I.1. Consignor

Name

Address

Postal code

I.2. Certificate reference No

I.2.a. Local reference No

I.3. Central competent authority

I.4. Local competent authority

I.5. Consignee

Name

Address

Postal code

I.6. No(s) of related original certificates

No(s) of accompanying documents

1.7. Dealer

Name

Approval number

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

Holding

Assembly centre

Dealer’s premis

Name

Approval/registration number

Address

Postal code

I.13. Place of destination

Holding

Assembly centre

Dealer’s premise

Name

Approval number

Address

Postal code

I.14. Place of loading

Postal code

I.15. Date and time of departure

I.16. Means of transport

Aeroplane

Ship

Railway wagon

Road vehicle

Other

Identification

Number(s):

I.17. Transporter

Name

Approval number

Address

Postal code

Member state

I.18. Description of commodity

I.19. Commodity code (CN code)

I.20. Quantity

I.21.

I.22. Number of packages

I.23. Seal/Container No

I.24.

I.25. Commodities certified for:

Slaughter

I.26. Transit through third country

Third country

ISO code

Exit point

Code

Entry point

BIP No

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. Estimated journey time

I.30. Route plan

Yes

No

I.31. Identification of the commodities

Species

(scientific name)

Official individual identification

Age

Sex

Breed

Quantity

Part II: Certification

EUROPEAN UNION

91/68 EI Ovine/Caprine for slaughter

II. Health information

II.a. Certificate reference number

II.b. Local reference number

I, the undersigned official veterinarian, hereby certify, that the animals described above meet the following requirements:

(1) either [II.1. The animals were born and have been reared since birth on Union territory.]

(1) or [II.1. The animals were imported from a third country complying with the animal health conditions laid down in Commission Regulation (EU) No 206/2010, at least 30 days prior to loading.]

II.2. The animals:

II.2.1. have been inspected today (within 24 hours prior to loading) and show no clinical sign of disease;

II.2.2. are not animals which are to be destroyed under a scheme to eradicate a contagious or infectious disease;

II.2.3. come from holdings which have been free from any official prohibition on health grounds, for the last 42 days in the case of brucellosis, for the last 30 days in the case of rabies, for the last 15 days in the case of anthrax, and have not been in contact with animals from holdings which did not comply with these conditions;

II.2.4. do not come from a holding nor have been in contact with animals from a holding in a protection zone which has been set up under Union legislation and which animals are prohibited to leave;

II.2.5. are not the subject of animal health measures pursuant to Union legislation on foot-and-mouth disease nor have been vaccinated against foot-and-mouth disease.

II.3. Based on the written declaration made by the keeper or an examination of the holding register and movement documents kept in accordance with Council Regulation (EC) No 21/2004, in particular in Sections B and C of the Annex to that Regulation:

II.3.1. the animals have been obtained from a holding in which they have been continuously resident for a period of at least 21 days prior to loading, or since birth in the holding of origin where the animals are less than 21 days old, and into which no biungulate animal imported from a third country has been introduced during the last 30 days prior to dispatch, unless those animals were introduced in accordance with Article 4a(2) of Directive 91/68/EEC, and

(1) either [have been obtained from a holding into which no animals of the ovine or caprine species have been introduced, unless those animals were introduced in accordance with Article 4a(1) of Directive 91/68/EEC, during the last 21 days prior to dispatch from the holding.]

(1) or [are to be consigned directly from a single holding to the slaughterhouse of destination.]

II.4.1. The animals were transported using means of transport and containment which had, before-hand, been cleansed and disinfected using an officially approved disinfectant, and in such a way as to provide effective protection of the animals’ health status.

II.4.2. Based on the official documentation accompanying the animals, the consignment covered by this health certificate is due to start the journey on … (insert date)(2).

II.4.3. At the time of inspection the animals covered by this health certificate were fit to be transported on the intended journey in accordance with the provisions of Council Regulation (EC) No 1/2005(3)(4).

II.5. This certificate

(1) either [is valid for 10 days from the date of inspection on the holding of origin, or in the approved assembly centre or approved dealer’s premises in the Member State of origin;]

(1) or [expires in accordance with Article 9(6) of Directive 91/68/EEC on … (insert date)](5).

Notes

Part I:

Box reference I.19.: Use the appropriate CN code under the following headings: 01.04.10 or 01.04.20.

Box reference I.23.: For containers or boxes, the container number and the seal number (if applicable) should be included.

Box reference I.31.: Identification system: The animals must bear: An individual number which permits tracing of their premises of origin, according to Council Regulation (EC) No 21/2004.

Age: (months).

Sex: (M = male, F = female, C = castrated)

EUROPEAN UNION

91/68 EI Ovine/Caprine for slaughter

II. Health information

II.a. Certificate reference number

II.b. Local reference number

Part II:

(1) Delete where not applicable.

(2) In the case where a consignment is grouped in an assembly centre and comprises animals that were loaded on different dates, the date on which the journey commenced for the whole consignment is considered to be the earliest date when any part of the consignment left the holding of origin.

(3) This statement does not exempt transporters from their obligations in accordance with Union rules in force in particular regarding the fitness of animals to be transported.

(4) To be completed in case of consignment grouped in an approved assembly centre or in approved dealer’s premises.

(5) To be completed in case of consignment grouped in an approved assembly centre located in the Member State of transit.

The colour of the stamp and the signature must be different from that of the other particulars in the certificate.

Official veterinarian or official inspector

Name (in Capital):

Qualification and title:

Local Veterinary Unit:

LVU No:

Date:

Signature:

Stamp:

Part I: Details of consignment presented

EUROPEAN UNION

Intra trade certificate

I.1. Consignor

Name

Address

Postal code

I.2. Certificate reference No

I.2.a. Local reference No

I.3. Central competent authority

I.4. Local competent authority

I.5. Consignee

Name

Address

Postal code

I.6. No(s) of related original certificates

No(s) of accompanying documents

1.7. Dealer

Name

Approval number

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

Holding

Assembly centre

Name

Approval/registration number

Address

Postal code

I.13. Place of destination

Holding

Assembly centre

Dealer’s premise

Name

Approval number

Address

Postal code

I.14. Place of loading

Postal code

I.15. Date and time of departure

I.16. Means of transport

Aeroplane

Ship

Railway wagon

Road vehicle

Other

Identification

Number(s):

I.17. Transporter

Name

Approval number

Address

Postal code

Member State

I.18. Description of commodity

I.19. Commodity code (CN code)

I.20. Quantity

I.21.

I.22. Number of packages

I.23. Seal/Container No

I.24.

I.25. Commodities certified for:

Fattening

I.26. Transit through third country

Third country

ISO code

Exit point

Code

Entry point

BIP No

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. Estimated journey time

I.30. Route plan

Yes

No

I.31. Identification of the commodities

Species

(scientific name)

Official individual identification

Age

Sex

Breed

Quantity

Part II: Certification

EUROPEAN UNION

91/68 EII Ovine/Caprine for fattening

II. Health information

II.a. Certificate reference number

II.b. Local reference number

I, the undersigned official veterinarian, hereby certify, that the animals described above meet the following requirements:

(1) either [II.1. The animals were born and have been reared since birth on Union territory.]

(1) or [II.1. The animals were imported from a third country complying with the animal health conditions laid down in Commission Regulation (EU) No 206/2010, at least 30 days prior to loading.]

II.2. The animals:

II.2.1. have been inspected today (within 24 hours prior to loading) and show no clinical sign of disease;

II.2.2. are not animals which are to be destroyed under a scheme to eradicate a contagious or infectious disease;

II.2.3. come from holdings which have been free from any official prohibition on health grounds, for the last 42 days in the case of brucellosis, for the last 30 days in the case of rabies, for the last 15 days in the case of anthrax, and have not been in contact with animals from holdings which did not comply with these conditions;

II.2.4. do not come from a holding nor have been in contact with animals from a holding in a protection zone which has been set up under Union legislation and which animals are prohibited to leave;

II.2.5. are not the subject of animal health measures pursuant to Union legislation on foot-and-mouth disease nor have been vaccinated against foot-and-mouth disease.

II.3. Based on the written declaration made by the keeper or an examination of the holding register and movement documents kept in accordance with Council Regulation (EC) No 21/2004, in particular in Sections B and C of the Annex to that Regulation, the animals have remained on a single holding of origin for a period of at least 30 days prior to loading, or on the holding of origin since birth where the animals are less than 30 days old, and no animal of the ovine and caprine species has been introduced into the holding of origin during the last 21 days prior to loading and no biungulate animal imported from a third country has been introduced into the holding of origin during the 30 days prior to dispatch from the holding of origin, unless those animals were introduced in accordance with Article 4a(1) of Directive 91/68/EEC.

(1) [II.4 The animals comply with the additional guarantees provided for in Article 7 or 8 of Council Directive 91/68/EEC and laid down for the Member State of destination or part of its territory …(insert Member State or part of its territory) in Commission Decision …/…/… (insert number).]

II.5. The animals comply with at least one of the following conditions and therefore qualify for admission to an ovine or caprine holding which is officially brucellosis-free (B. melitensis):

(1) either [the holding of origin is situated in a Member State or part of its territory … (insert name of Member State or part of its territory) which is recognised as being officially brucellosis-free in accordance with Commission Decision …/…/… (insert number).]

(1) or [come from an officially brucellosis-free (B. melitensis) holding.]

(1) or [come from a brucellosis-free (B. melitensis) holding, and

(i) are identified individually,

(ii) have never been vaccinated against brucellosis or if the animals have been vaccinated were so vaccinated more than two years previously or the animals are females over two years old which were vaccinated before the age of seven months,

(iii) were isolated under official supervision on the holding of origin and, during such isolation, underwent, with negative results, two tests for brucellosis in accordance with Annex C to Directive 91/68/EEC, separated by an interval of at least six weeks.]

II.6. The animals comply with at least one of the following conditions and therefore qualify for admission to an ovine or caprine holding which is brucellosis-free (B. melitensis):

(1) either [come from an officially brucellosis-free (B. melitensis) holding.]

(1) and/or [come from a brucellosis-free (B. melitensis) holding.]

(1) and/or [until the qualifying date under eradication plans approved pursuant to Council Decision 90/242/EEC, the animals originate from a holding other than officially brucellosis-free or brucellosis-free and comply with the following conditions:

(i) are identified individually,

(ii) originate from a holding in which all the animals of species susceptible to brucellosis (B. melitensis) have been free of clinical symptoms or any other symptoms of brucellosis for at least 12 months; and

EUROPEAN UNION

91/68 EII Ovine/Caprine for fattening

II. Health information

II.a. Certificate reference number

II.b. Local reference number

(1) either [have not been vaccinated against brucellosis (B. melitensis) in the last two years, and were isolated under veterinary supervision on the holding of origin and, during such isolation, underwent, with negative results, two tests for brucellosis in accordance with Annex C to Directive 91/68/EEC, separated by an interval of at least six weeks.]

(1) or [were vaccinated with Rev. 1 vaccine before the age of seven months, but not later than 15 days before their introduction into the holding of destination.]]

(1) [II.7. the animals are intended for a Member State with a negligible risk status for classical scrapie approved in accordance with point 2.2 of Section A of Chapter A of Annex VIII to Regulation (EC) No 999/2001 of the European Parliament and of the Council or which is listed in point 3.2 of Section A of Chapter A of Annex VIII to Regulation (EC) No 999/2001 as having an approved national scrapie control programme, and

(1) either [come from a Member State or zone of a Member State with a negligible risk status for classical scrapie approved in accordance with point 2.2 of Section A of Chapter A of Annex VIII to Regulation (EC) No 999/2001.]

(1) and/or [are ovine animals of the ARR/ARR prion protein genotype and do not come from a holding subject to the measures laid down in points 3 and 4 of Chapter B of Annex VII to Regulation (EC) No 999/2001.]

(1) and/or [come from a holding or holdings recognised as having a negligible risk of classical scrapie in accordance with point 1.2 of Section A of Chapter A of Annex VIII to Regulation (EC) No 999/2001.]

(1) and/or [come from a holding or holdings which have complied with the requirements laid down in point 1.2(a) to (i) of Section A of Chapter A of Annex VIII to Regulation (EC) No 999/2001 for a period of at least the last seven years and arrive at the holding of destination before 1 January 2015.]]

II.8.1. The animals were transported using means of transport and containment which had, before-hand, been cleansed and disinfected using an officially approved disinfectant, and in such a way as to provide effective protection of the animals’ health status.

II.8.2. Based on the official documentation accompanying the animals, the consignment covered by this health certificate are due to start the journey on … (insert date) (2).

II.8.3. At the time of inspection the animals covered by this health certificate were fit to be transported on the intended journey in accordance with the provisions of Council Regulation (EC) No 1/2005 (3).

Notes

Part I:

Box reference I.19.: Use the appropriate CN code under the following headings: 01.04.10 or 01.04.20.

Box reference I.23.: For containers or boxes, the container number and the seal number (if applicable) should be included.

Box reference I.31.: Identification system: The animals must bear: An individual number which permits tracing of their premises of origin, according to Council Regulation (EC) No 21/2004.

Age: (months).

Sex: (M = male, F = female, C = castrated)

Part II:

(1) Delete where not applicable.

(2) In the case where a consignment is grouped in an assembly centre and comprises animals that were loaded on different dates, the date on which the journey commenced for the whole consignment is considered to be the earliest date when any part of the consignment left the holding of origin.

(3) This statement does not exempt transporters from their obligations in accordance with Union rules in force in particular regarding the fitness of animals to be transported.

This certificate is valid for 10 days.

The colour of the stamp and the signature must be different from that of the other particulars in the certificate.

EUROPEAN UNION

91/68 EII Ovine/Caprine for fattening

II. Health information

II.a. Certificate reference number

II.b. Local reference number

Official veterinarian or official inspector

Name (in Capital):

Qualification and title:

Local Veterinary Unit:

LVU No:

Date:

Signature:

Stamp:

Part I: Details of consignment presented

EUROPEAN UNION

Intra trade certificate

I.1. Consignor

Name

Address

Postal code

I.2. Certificate reference No

I.2.a. Local reference No

I.3. Central competent authority

I.4. Local competent authority

I.5. Consignee

Name

Address

Postal code

I.6. No(s) of related original certificates

No(s) of accompanying documents

1.7. Dealer

Name

Approval number

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

Holding

Assembly centre

Name

Approval/registration number

Address

Postal code

I.13. Place of destination

Holding

Assembly centre

Dealer’s premise

Name

Approval number

Address

Postal code

I.14. Place of loading

Postal code

I.15. Date of departure

I.16. Means of transport

Aeroplane

Ship

Railway wagon

Road vehicle

Other

Identification

Number(s):

I.17. Transporter

Name

Approval number

Address

Postal code

Member State

I.18. Description of commodity

I.19. Commodity code (CN code)

I.20. Quantity

I.21.

I.22. Number of packages

I.23. Seal/Container No

I.24.

I.25. Commodities certified for:

Breeding

I.26. Transit through third country

Third country

ISO code

Exit point

Code

Entry point

BIP No

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. Estimated journey time

I.30. Route plan

Yes

No

I.31. Identification of the commodities

Species

(scientific name)

Official individual identification

Age

Sex

Breed

Quantity

Part II: Certification

EUROPEAN UNION

91/68 EIII Ovine/Caprine for breeding

II. Health information

II.a. Certificate reference number

II.b. Local reference number

I, the undersigned official veterinarian, hereby certify, that the animals described above meet the following requirements:

(1) either [II.1. The animals were born and have been reared since birth on Union territory.]

(1) or [II.1. The animals were imported from a third country complying with the animal health conditions laid down in Commission Regulation (EU) No 206/2010, at least 30 days prior to loading.]

II.2. The animals:

II.2.1. have been inspected today (within 24 hours prior to loading) and show no clinical sign of disease;

II.2.2. are not animals which are to be destroyed under a scheme to eradicate a contagious or infectious disease;

II.2.3. come from holdings which have been free from any official prohibition on health grounds, for the last 42 days in the case of brucellosis, for the last 30 days in the case of rabies, for the last 15 days in the case of anthrax, and have not been in contact with animals from holdings which did not comply with these conditions;

II.2.4. do not come from a holding nor have been in contact with animals from a holding in a protection zone which has been set up under Union legislation and which animals are prohibited to leave;

II.2.5. are not the subject of animal health measures pursuant to Union legislation on foot-and-mouth disease nor have been vaccinated against foot-and-mouth disease.

II.3. Based on the written declaration made by the keeper or an examination of the holding register and movement documents kept in accordance with Council Regulation (EC) No 21/2004, in particular in Sections B and C of the Annex to that Regulation, the animals have remained on a single holding of origin for a period of at least 30 days prior to loading, or on the holding of origin since birth where the animals are less than 30 days old, and no animal of the ovine and caprine species has been introduced into the holding of origin during the last 21 days prior to loading and no biungulate animal imported from a third country has been introduced into the holding of origin during the 30 days prior to dispatch from the holding of origin, unless those animals were introduced in accordance with Article 4a(1) of Directive 91/68/EEC.

(1) [II.4. The animals comply with the additional guarantees provided for in Article 7 or 8 of Council Directive 91/68/EEC and laid down for the Member State of destination or part of its territory … (insert Member State or part of its territory) in Commission Decision … / … / … (insert number).]

II.5. The animals comply with at least one of the following conditions and therefore qualify for admission to an ovine or caprine holding which is officially brucellosis-free (B. melitensis):

(1) either [the holding of origin is situated in a Member State or part of its territory … (insert Member State or part of its territory) which is recognised as being officially brucellosis-free in accordance with Commission Decision … / … / … (insert number).]

(1) or [come from an officially brucellosis-free (B. melitensis) holding.]

(1) or [come from a brucellosis-free (B. melitensis) holding, and

(i) are identified individually,

(ii) have never been vaccinated against brucellosis or if the animals have been vaccinated were so vaccinated more than two years previously or the animals are females over two years old which were vaccinated before the age of seven months,

(iii) were isolated under official supervision on the holding of origin and, during such isolation, underwent, with negative results, two tests for brucellosis in accordance with Annex C to Directive 91/68/EEC, separated by an interval of at least six weeks.]

II.6. The animals comply with at least one of the following conditions and therefore qualify for admission to an ovine or caprine holding which is brucellosis-free (B. melitensis):

(1) either [come from an officially brucellosis-free (B. melitensis) holding.]

(1) or [come from a brucellosis-free (B. melitensis) holding.]

(1) or [until the qualifying date under eradication plans approved pursuant to Council Decision 90/242/EEC, the animals originate from a holding other than officially brucellosis-free or brucellosis-free and satisfy the following conditions:

(i) are identified individually,

EUROPEAN UNION

91/68 EIII Ovine/Caprine for breeding

II. Health information

II.a. Certificate reference number

II.b. Local reference number

(ii) originate from a holding in which all the animals of species susceptible to brucellosis (B. melitensis) have been free of clinical symptoms or any other symptoms of brucellosis for at least 12 months; and

(1) either [have not been vaccinated against brucellosis (B. melitensis) in the last two years, and were isolated under veterinary supervision on the holding of origin and, during such isolation, underwent, with negative results, two tests for brucellosis in accordance with Annex C to Directive 91/68/EEC, separated by an interval of at least six weeks.]

(1) or [were vaccinated with Rev. 1 vaccine before the age of seven months, and were not vaccinated in the 15 days before the date of emission of this health certificate.]

(1) [II.7. They are uncastrated breeding rams and:

(i) come from a holding on which no case of contagious epididymitis of rams (B. ovis) has been recorded in the past 12 months,

(ii) have been kept permanently on that holding for the 60 days preceding consignment,

(iii) have undergone, within 30 days prior to consignment, with a negative result, a test to detect contagious epididymitis of rams (B. ovis) in accordance with Annex D to Directive 91/68/EEC.]

II.8. To the best of the knowledge of the undersigned and according to the written declaration made by the owner, the animals were not obtained from a holding nor have been in contact with animals from a holding in which the following diseases have been clinically detected:

(i) within the last six months, contagious agalactia of sheep (Mycoplasma agalactiae) and contagious agalactia of goats (Mycoplasma agalactiae, M. capricolum, M. mycoides subsp. mycoides large colony),

(ii) within the last 12 months, paratuberculosis or caseous lymphadenitis,

(iii) within the last three years, pulmonary adenomatosis, maedi/visna or caprine viral arthritis/encephalitis. However, this time limit is reduced to 12 months if animals affected by maedi/visna or caprine viral arthritis/encephalitis have been slaughtered and the remaining animals have reacted negatively to two tests.

(1) either[II.9. The animals come from a Member State or zone of a Member State with a negligible risk status for classical scrapie approved in accordance with point 2.2 of Section A of Chapter A of Annex VIII to Regulation (EC) No 999/2001 of the European Parliament and of the Council.]

(1) and/or [are ovine animals of the ARR/ARR prion protein genotype and do not come from a holding subject to the measures laid down in points 3 and 4 of Chapter B of Annex VII to Regulation (EC) No 999/2001.]

(1) and/or [come from a holding or holdings recognised as having a negligible risk of classical scrapie in accordance with point 1.2 of Section A of Chapter A of Annex VIII to Regulation (EC) No 999/2001.]

(1) and/or [II.9. The animals are intended for a Member State other than those with a negligible risk status for classical scrapie approved in accordance with point 2.2 of Section A of Chapter A of Annex VIII to Regulation (EC) No 999/2001 or other than those which are listed in point 3.2 of Section A of Chapter A of Annex VIII to Regulation (EC) No 999/2001 as having an approved national scrapie control programme, and

(1) either [come from a holding or holdings recognised as having a controlled risk of classical scrapie approved in accordance with point 1.3 of Section A of Chapter A of Annex VIII to Regulation (EC) No 999/2001.]

(1) and/or [come from a holding or holdings which have complied with the requirements laid down in point 1.3(a) to (f) of Section A of Chapter A of Annex VIII to Regulation (EC) No 999/2001 for a period of at least the last three years and arrive at the holding of destination before 1 January 2015.]]

(1) and/or [II.9. The animals are intended for a Member State with a negligible risk status for classical scrapie approved in accordance with point 2.2 of Section A of Chapter A of Annex VIII to Regulation (EC) No 999/2001, and come from a holding or holdings which have complied with the requirements laid down in point 1.2(a) to (i) of Section A of Chapter A of Annex VIII to Regulation (EC) No 999/2001 for a period of at least the last seven years and arrive at the holding of destination before 1 January 2015.]

II.10.1 The animals were transported using means of transport and containment which had, before-hand, been cleansed and disinfected using an officially approved disinfectant, and in such a way as to provide effective protection of the animals’ health status.

EUROPEAN UNION

991/68 EIII Ovine/Caprine for breeding

II. Health information

II.a. Certificate reference number

II.b. Local reference number

II.10.2 Based on the official documentation accompanying the animals, the consignment covered by this health certificate are due to start the journey on … (insert date) (2)

II.10.3 At the time of inspection the animals covered by this health certificate were fit to be transported on the intended journey in accordance with the provisions of Council Regulation (EC) No 1/2005 (3)

Notes

Part I:

Box reference I.19.: Use the appropriate CN code under the following headings: 01.04.10 or 01.04.20.

Box reference I.23.: For containers or boxes, the container number and the seal number (if applicable) should be included.

Box reference I.31.: Identification system: The animals must bear: An individual number which permits tracing of their premises of origin, according to Council Regulation (EC) No 21/2004.

Age: (months).

Sex: (M = male, F = female, C = castrated).

Part II:

(1) Delete where not applicable.

(2) In the case where a consignment is grouped in an assembly centre and comprises animals that were loaded on different dates, the date at which the journey commenced for the whole consignment is considered to be the earliest date when any part of the consignment left the holding of origin.

(3) This statement does not exempt transporters from their obligations in accordance with Union rules in force in particular regarding the fitness of animals to be transported.

This certificate is valid for 10 days.

The colour of the stamp and the signature must be different from that of the other particulars in the certificate.

Official veterinarian or official inspector

Name (in Capital):

Qualification and title:

Local Veterinary Unit:

LVU No:

Date:

Signature:’

Stamp: