Aphis 2017 Official Export Certificate For Animal Biological Produc

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0013. The time required to complete this information collection is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

OMB Approved 0579-0013 EXP. DATE XX/XXXX

This certificate is required for foreign countries to furnish official certification by the Veterinary Services the certain products have been prepared in accordance with Virus-Serum-Toxin Act (9 CFR 112).

UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTIIINSPECTION SERVICE VETERINARY SERVICES OFFICIAL EXPORT CERTIFICATE FOR ANIMAL BIOLOGICAL PRODUCTS

IMPORTANT: Complete Items 1 thru 11 Submit an Original to: USDA-APHIS-VS Center for Veterinary Biologics Inspection and Compliance 510 S. 17th Street, Suite 104 Ames, IL 50010

1. DESTINATION (Name and Address of Consignee)

2. NAME AND ADDRESS OF CONSIGNOR (Include ZIP Code)

TO BE COMPLETED BY VETERINARY SERVICES

Certificate NUMBER

DATE ISSUED

ISSUED AT

3. PRODUCT CODE NUMBER. (Numerical order)

4. NAME OF PRODUCT

5. SERIAL NUMBER

FINAL CONTAINERS

8. EXPIRATION DATE

9. LICENSE NUMBER

6. NUMBER

7. SIZE (cc, dose, test, or unit)

10. NUMBER SHIPPING BOXES

11. SHIPPING MARKS

This certifies that the biological products described above, intended for use in the treatment of animals, have been produced under United Slates Veterinary Biologics Establishment License, issued by Veterinary Services is provided by the Virus-Serum-Toxin Act (37 Stat. 832-·833, 21 U.S.C. 151 - 158) and regulations prescribed thereunder and are at this date Suitable for use In this country

12. SIGNATURE OF CERTIFYING OFFICIAL

13. TITLE

14. DATE

APHIS FORM 2017 Previous editions are obsolete.

OCT 2011