DA-244 Sanitary Certificate Request - Chile

Form approved OMB No. 0581-0283
U. S DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE SANITARY CERTIFICATE REQUEST			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 0581-0283. 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.
TYPE Faxed Certificate* 0 Additional Copies* *additional charges apply
I acknowledge that by checking this box that the information provided is factual and accurate.
CONTACT NAME		     		MAIL CERTIFICATE TO:
AMS BILLING ACCT.		     		7. COMPANY		     
BILLING REFERENCE		     		8. CONTACT		     
E-MAIL ADDRESS		     		9. STREET		     
CONTACT PHONE		     		10. CITY		     
FAX		     		11. STATE		     		12. ZIP	     
CONSIGNOR
14. NAME		     
15. ADDRESS		     
16. CITY/STATE		     
CONSIGNEE
17. NAME		     
18. ADDRESS		     
19. COUNTRY CODE		CL
IDENTIFICATION OF DAIRY PRODUCTS
20. DESCRIPTION OF COMMODITY						     
21. KIND OF HEAT TREATMENT (HTST; PAST.)						     
22. TYPE OF PACKAGING						     
23. NUMBER OF PACKAGING UNITS						     
24. NET WEIGHT						     
25. REQUIRED TEMPERATURE DURING STORAGE AND TRANSPORTATION						     
     						     
27. EXPIRATION DATE						     
MANUFACTURER
28. PLANT NUMBER	     ;      ;      
SHIPMENT INFORMATION
     	     			30. ENTRY PORT			     
31. TRANSPORT TYPE	     			32. TRANSPORT NAME			     
33. CONTAINER NUMBER	     
34. SEAL NUMBER	     
SIGNATURE (for faxed or mailed copies)					35. DATE January 16, 2021

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

DA-244 (01/2013)

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD).

To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.