Fillable Veterinary Health Certificate for Export of Dogs and

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Veterinary Health Certificate for Export of Dogs and

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Page 1 of 2
Veterinary Health Certificate for Export of Dogs and Cats
from the United States of America to Thailand
Veterinary Authority
UNITED STATES DEPARTMENT OF AGRICULTURE
Date Of Issue Certificate Number
1. Consignor:
2. Consignee:
3. Country Of Origin:
United States of America
4. State Of Origin:
5. Country Of Destination:
Thailand
6. Zone of Destination:
**************************************************************************************
7. Place Of Origin:
**************************************************************************************
**************************************************************************************
**************************************************************************************
8. Port of Embarkation / Border Crossing:
**************************************************************************************
**************************************************************************************
**************************************************************************************
9. Estimated Date Of Shipment:
10. Means Of Transport:
11.
**************************************************************************************
**************************************************************************************
12. CITES Permit Number:
**************************************************************************************
**************************************************************************************
13. Description Of Commodity:
DOG(S) CAT(S)
14.
**************************************************************************************
**************************************************************************************
15. Total Quantity:
16. Total Number Of Packages/Containers:
**************************************************************************************
**************************************************************************************
17. Additional Information:
***********************************************************************************************************************************************************************************
***********************************************************************************************************************************************************************************
18. Identification / Seal Numbers:
*****************************************************************************************************************
*********************************************************************
************************************************************************************************************************************************************************************
**
19. Commodities Intended Use:
Pet (Personal)
20. Type Of Admission:
**************************************************************************************
**************************************************************************************
21. Identification Of Commodities:
Microchip or Tattoo
Number
Species Breed Age* Sex
Color or Distinctive Markings
* Pets must be at least 4 months of age at the time of import to be allowed entry into Thailand.
Page 2 of 2
Veterinary Authority
UNITED STATES DEPARTMENT OF AGRICULTURE
Date Of Issue
Certificate Number
Certification Statements:
1. I have verified the presence of the microchips or tattoos listed in box 21.
2. I certify that the animals described in box 21 have been inspected by me on this date, within 10 days of departure, and appear to be
free of any infectious or contagious diseases and, to the best of my knowledge, exposure thereto, which would endanger the animals
or other animals or would endanger public health.
3. To my knowledge, the animals described in box 21 originated from an area not quarantined for rabies and has/have not been exposed
to rabies.
4. For cats, the following vaccines were administered on the listed date, which is at least 21 days before departure, and are still valid:
Date of Most Recent Vaccine Administration
Microchip/Tattoo Number Rabies Feline Panleukopenia
5. For dogs, the following vaccines were administered on the listed date, which is at least 21 days before departure, and are still valid:
Date of Most Recent Vaccine Administration
Microchip/Tattoo Number Rabies
not tested as
Canine Distemper
Virus
Infectious Canine
Hepatitis
Canine Parvovirus
6. Dogs were tested* for Leptospirosis with negative results during the 30 days prior to departure on: ________________________
* Not required for dogs that have a valid vaccine for Leptospirosis noted in #5 above.
This certificate is valid for 10 days after issuance.
Name of USDA-Accredited Veterinarian
Name of USDA Veterinarian
Signature of Accredited Veterinarian
Signature of USDA Veterinarian
Date
Date
Updated February 2017
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Completed 21 July 2021

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