Vs Form 17-6 - Certificate For Poultry Or Hatching Eggs For Export

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OMB Approved

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 0579-0328. The time required to complete this information collection

0579-0328

is estimated to average .5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed,

EXP. 3/31/2020

and completing and reviewing the collection of information.

This certificate is authorized by law (21 U.S.C. 112). While you are not required to respond, no health certificate can be validated unless the data required are provided.

UNITED STATES DEPARTMENT OF AGRICULTURE

1. DATE OF SHIPMENT

ANIMAL AND PLANT HEALTH INSPECTION SERVICE

VETERINARY SERVICES

No.

CERTIFICATE FOR POULTRY OR HATCHING EGGS FOR EXPORT

2. NAME AND ADDRESS OF EXPORTER (include ZIP Code)

3. NAME AND ADDRESS OF IMPORTER

FIPS STATE CODE (for USDA use only)

FIPS COUNTRY CODE (for USDA use only)

6. PRODUCT

7. SEX

9. NPIP APPROVAL NUMBER

8. TYPE (intended use) ("X" or check)

("X" or check)

Commercial

Multiplier

Primary

Production

Breeding

10. NPIP CLASSIFICATION-U.S.

Stock

4.QUANTITY/UNIT

5. VARIETY, STRAIN, OR

("X" or check)

(Eggs-Dozen)

TRADE NAME

Other

(specify)

(Poultry-Number)

11. TOTAL NUMBER OF UNITS CERTIFIED FOR EXPORT

12. CHECK APPROPRIATE CERTIFICATION BELOW (A OR B)

Certificate for Hatching Eggs and Newly Hatched Poultry, which have not been fed or watered. This is to certify that: (1) the flock or flocks and the hatchery or

hatcheries from which the above-described hatching eggs or newly hatched poultry originated were inspected by me or another accredited veterinarian within 30

days prior to shipment of above hatching eggs or setting of eggs for above shipment of day old chicks and found free from evidence of communicable diseases

and insofar as can be determined have not been exposed to Newcastle disease, fowl plague, fowl typhoid, ornithosis, and pullorum disease; (2) during the usual

routine inspection of the flock or flocks there was no visible evidence of communicable diseases observed on the inspection dates listed in item 13 below; (3) the

National Poultry Improvement Plan classification is as indicated in item 9 above, and (4) the prospective exporter has been advised that the hatching eggs must

be clean and that the shipment must be made in new, clean containers.

Certificate for Poultry other than Newly Hatched Poultry Specified in Certificate A. This is to certify that: (1) on this date all poultry shown in item 5 above,

including all other poultry maintained in the flock, were inspected by me on the premises of origin within the past 30 days and found free from evidence of

infectious and contagious diseases and insofar as can be determined have not been exposed to Newcastle disease, fowl plague, fowl typhoid, ornithosis and

pullorum disease; and (2) the prospective exporter has been advised that shipment must be made in new containers or clean containers which have been

properly cleaned and disinfected.

13. REMARKS OR ADDITIONAL INFORMATION (if needed)

14. TYPED NAME OF ISSUING VETERINARIAN

15. SIGNATURE OF ISSUING VETERINARIAN

16. STATUS

17. DATE ISSUED

1. State

2. Federal

3. Accredited

18. SIGNATURE OF ENDORSING FEDERAL VETERINARIAN (if required)

19. DATE ENDORSED