Sanitary Certificate Request - Tunisia

Form Approved OMB No. 0581-NEW

U. S DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE SANITARY CERTIFICATE REQUEST- TUNISIA

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. This valid OMB control number for this collection is 0581-NEW. The time required to complete this information collection is estimated to average 12 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection information.

I acknowledge that by checking this box that the information provided is factual and accurate.

CONTACT NAME

     

MAIL CERTIFICATE TO:

CUSTOMER NUMBER

     

7. COMPANY

     

BILLING REFERENCE

     

8. CONTACT

     

E-MAIL ADDRESS

     

9. STREET

     

CONTACT PHONE

     

10. CITY

     

FAX

     

11. STATE

     

12. ZIP

     

13. Type

Faxed Certificate*

0 Additional Copies*

*additional charges apply

EXPORTER

14. NAME

     

15. ADDRESS

     

16. CITY, STATE

     

IDENTIFICATION OF DAIRY PRODUCTS

17. DESCRIPTION OF COMMODITY

     

18. TYPE OF PACKAGING

     

19. NUMBER OF PACKAGING UNITS

0

20. NET WEIGHT

     

MANUFACTURER

PLANT NUMBER

LOT NUMBER

PRODUCTION DATE

NUMBER OF UNITS

NET WEIGHT

21.      

     

     

     

     

21.      

     

     

     

     

21.      

     

     

     

     

PLACE OF LOADING

22. CITY, STATE

     

DESTINATION

23. NAME OF RECEIVER

     

24. CITY

     

SIGNATURE OF AGENT FOR APPLICANT

25. DATE      

**For fastest processing, please attach this form and a PDF shipping label in an email to DairySanitaryCerts@ams.usda.gov.

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