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 0579-0256. The time
required to complete this information collection is estimated to average .5 hours 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
0579-0256
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
EXPORT CERTIFICATE FOR
ANIMAL PRODUCTS
Port:
FOR OFFICIAL USE ONLY
Date:
Certificate Number:
This certificate is for veterinary purposes only. It is valid for 30 days after the date of signature (in the case of transport by ship or rail, the time is prolonged by the time of the
voyage).
This is to certify that rinderpest, foot-and-mouth disease, classical swine fever, swine vesicular disease, African swine fever, and contagious bovine pleuropneumonia do not
exist in the United States of America.
ADDITIONAL DECLARATIONS
SIGNATURE OF ENDORSING OFFICIAL: TYPED NAME:
TITLE OF ENDORSING OFFICIAL:
DESCRIPTION OF THE CONSIGNMENT
NAME AND ADDRESS OF EXPORTER:
NAME AND ADDRESS OF CONSIGNEE:
PRODUCT (type of product, quantity, unit of measure, and animal product species of origin):
IDENTIFICATION:
CONVEYANCE:
VS Form 16-4
MAR 2010
