Application For Embryo Export Form - 2008
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2D. APPLICATION FOR EMBRYO EXPORT
Page ___ of ___
BREED ________
Exporters I.D. ___________
Application for International Movement. To be submitted to breed organization in exporting country.
Name of Buyer _____________________________________________________________________________________________________________
Address ___________________________________________________________________________________________________________________
Country ___________________________________________________________________________________________________________________
Sale Date __________ Export Date __________
Certification of DNA Genotyping/Blood Typing needed
Yes _________ No ________
Ear Tag
Donor Name
____________________________________________ No. ______ ____________________________ or Tattoo __________________
CC
Owner __________________________________________________
Address ______________________________________________________
AM
Onset
PM
_______________________________________________________________________________________
Estrus Date
____________
Yr. Mo. Day
Service Sire
____________________________________________ No. ______ ____________________________ Breeding Date ______________
CC
Yr. Mo. Day
Sexed Semen X or Y _____
Service Sire
____________________________________________ No. ______ ____________________________ Recovery Date _____________
CC
Yr. Mo. Day
Sexed Semen X or Y _____
Signature of Seller _______________________________________________________________________________
Total Recovered
__________
Owner of Donor Dam on Date of Recovery
No. Cleaved/Degen. ________
Address ________________________________________________________________________________________
No. Unfertilized ____________
No. Transferred ____________
Signature ________________________________________________
Firm
____________________________
No. Frozen _______________
Practitioner or Leader of Embryo Production Team Recovering Embryos
ET Code _______________
CERTIFICATE OF FREEZING AND/OR IDENTIFICATION OF EMBRYOS
(see reverse side for coding instructions)
In lieu of completing this portion of this form, certificate A-C may be attached
Type of Container:
Straw ____ Other ____ Each container labeled to show firm code, breed, reg. no. of donor, freeze date and straw no.
Embryo
Cane
Straw
No. Embryos/
No. X
Trypsin
Code
Code
Zona
Manipulated
No.
No.
Straw
Washed
Treated
Stage
Quality
Intact
N, D, F, M or U
Comments
____________
____________ ____________ _________ _________ ________ ________ ________ ____________ ________________________
____________
____________ ____________ _________ _________ ________ ________ ________ ____________ ________________________
____________
____________ ____________ _________ _________ ________ ________ ________ ____________ ________________________
____________
____________ ____________ _________ _________ ________ ________ ________ ____________ ________________________
____________
____________ ____________ _________ _________ ________ ________ ________ ____________ ________________________
____________
____________ ____________ _________ _________ ________ ________ ________ ____________ ________________________
____________
____________ ____________ _________ _________ ________ ________ ________ ____________ ________________________
____________
____________ ____________ _________ _________ ________ ________ ________ ____________ ________________________
Time from recovery to onset of freezing ________ (hrs.) Cyroprotectant and concentration; equilibration, final molality and cooling procedure ______________
__________________________________________________________________________________________________________________________
How Frozen:
Seed Temp. __________
Cooling Rate __________
Plunge Temp. __________
Other ______________________________
Recommended method of thawing and dilution ____________________________________________________________________________________
__________________________________________________________________________________________________________________________
Signature ___________________________________________________
Firm _______________________________________________________
Practitioner or Leader of Embryo Production Team Freezing the Embryos
ET Code _____________________ Phone (
) ________________
Signature ___________________________________________________
Firm _______________________________________________________
Exporter
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