I.1. Avsender Sertifikat til bruk ved handel innenfor Fellesskapet I.2. Sertifikatets referansenummer I.2.a. Lokalt referansenummer: I.3. Vedkommende sentrale myndighet Del I: Opplysninger om forsendelsen I.4. Vedkommende lokale myndighet Land I.5. Mottaker I.6. Nr. på tilhørende originalsertifikat(er) Nr. på følgedokument(er) I.7. Forhandler Land I.8. Opprinnelsesland ISO-kode I.9. Opprinnelsesregion Kode I.10. Mottakerstat ISO-kode I.11. Bestemmelsesregion Kode I.12. Opprinnelsessted/fangststed I.13. Bestemmelsessted Driftsenhet Oppsamlingssentral Lokalene til en forhandler Driftsenhet Oppsamlingssentral Lokalene til en forhandler Godkjent organ Sædstasjon Godkjent akvakulturanlegg Godkjent organ Sædstasjon Godkjent akvakulturanlegg Embryogruppe Virksomhet Annet Embryogruppe Virksomhet Annet I.14. Lastested I.15. Avgangsdato og -klokkeslett I.16. Transportmiddel Fly Skip Jernbanevogn Veitransport Annet Identifikasjon:: Nummer: I.21 Temperatur i produktene Omgivelses- Kjølt Fryst I.23. Containernummer/plombenummer I.17. Transportør I.20. Antall/mengde I.22. Antall kolli Medlemsstat I.25. Dyr sertifisert til / produkter sertifisert til: Kunstig reproduksjon I.26. Transitt gjennom tredjestat I.27. Transitt gjennom medlemsstater Utførselssted Innførselssted Kode GKS-nr. I.28. Eksport Tredjestat Utførselssted I.30. Reiseplan Ja Nei ISO-kode Kode I.29. Forventet transporttid I.31. Identifikasjon av dyrene Art Rase [nw] Donor identity Innsamlingsdato(er) [nw] Approval number of the centre Mengde nw 1/ 5
88/407 (2016/2008) Bovine semen D3 II. Helseinformasjon II.a. Sertifikatets referansenummer II.b. Lokalt referansenummer: II.1. Animal Health Attestation I, the undersigned official veterinarian, hereby certify that the semen described above: as collected, processed and stored for a minimum period of 30 days immediately following collection in a semen collection centre(2) situated in the Member State of origin of the semen and operated and supervised in accordance with Chapter I and Chapter II of Annex A to Directive 88/407/EEC, and from where the semen was accepted into the semen storage centre detailed in Box I.12. situated in the same Member State of origin of the semen under animal health and veterinary certification conditions at least as strict as those provided for in: Del II: Attestering [Annex D1 to Directive 88/407/EEC(3);] [Annex D2 to Directive 88/407/EEC(4);] [Annex D3 to Directive 88/407/EEC(3) (4);] [until 31 October 2011, Annex D3 to Directive 88/407/EEC(3) (4) (5);] ] as collected, processed and stored for a minimum period of 30 days immediately following collection in a semen collection centre(2) situated in the European Union and operated and supervised in accordance with Chapter I and Chapter II of Annex A to Directive 88/407/EEC and was accepted into the semen storage centre detailed in Box I.12., in accordance with: [Annex D1 to Directive 88/407/EEC(3);] [Annex D2 to Directive 88/407/EEC(4);] [Annex D3 to Directive 88/407/EEC(3) (4);] [until 31 October 2011, Annex D3 to Directive 88/407/EEC(3)(4)(5);] ] as collected, processed and stored for a minimum period of 30 days immediately following collection in a semen collection centre(2) situated in a third country or part(s) thereof listed in Annex I to Decision 2011/630/EU which is operated and supervised in accordance with Chapter I and Chapter II of Annex A to Directive 88/407/EEC, and was imported into the European Union under the conditions of Articles 8 to 12 of Directive 88/407/EEC in accordance with: Notes [Section A of Part 1 of Annex II to Decision 2011/630/EU (3);] [until 31 October 2011, Part 1 of Annex II to Decision 2004/639/EC(3);] [Section B of Part 1 of Annex II to Decision 2011/630/EU (4);] [until 31 October 2011, Part 2 of Annex II to Decision 2004/639/EC(4);] [Section C of Part 1 of Annex II to Decision 2011/630/EU (3) (4);] [until 31 October 2011, Part 3 of Annex II to Decision 2004/639/EC(3) (4);] ] II.2. was stored in the semen storage centre(2) indicated in Box I.12. which is operated and supervised in accordance with Chapter I(2) and Chapter II(2) of Annex A to Directive 88/407/EEC. Bluetongue exemption from exit ban: Semen in compliance with Article 8(a) or 8(b) of Regulation (EC) No 1266/2007 Semen obtained from donor animals which comply with (point (a), (b), (c), (d) or (e), indicate as appropriate) of Annex III.B to Regulation (EC) No 1266/2007 II.2 (Semen, ova embryos, indicate as appropriate) in compliance with (Article 7 or 7(2), indicate as appropriate) of Commission Implementing Decision (EU) 2016/2008 concerning animal health control measures relating to lumpy skin disease in certain Member States. Part I: Box I.6.: Box I.12.: Box I.13.: Box I.23.: Box I.31.: Number(s) of related original certificates shall correspond to the serial number(s) of the individual official national document(s), INTRA health certificate(s) or CVED(s) that accompanied the semen described above from the semen collection centre of its origin to the described above semen storage centre. place of origin shall correspond to the semen storage centre (as defined in Article 2(b) of Directive 88/407/EEC) of dispatch of the semen. place of destination shall correspond to the semen collection or storage centre (as defined in Article 2(b) of Directive 88/407/EEC), or to the holding of semen destination. identification of container and seal number shall be indicated. donor identity shall correspond to the official identification of the animal. date of collection shall be indicated in the following format: dd/mm/yyyy. approval number of the centre shall correspond to the approval number of the semen collection centre of the semen origin. Part II: (2) (3) (4) (5) Delete as appropriate Only semen collection or storage centres listed in accordance with Article 5(2) or Article 9 of Directive 88/407/EEC on the Commission websites: http://ec.europa.eu/food/animal/approved_establishments/establishments_vet_field_en.htm, http://ec.europa.eu/food/animal/semen_ova/bovine/index_en.htm. For semen collected, processed and stored in accordance with provisions of Directive 88/407/EEC, as amended by Directive 2003/43/EC. For semen collected, processed and stored before 31 December 2004 in conformity with the provisions of Directive 88/407/EEC applying until 1 July 2004. Annex D3 to Directive 88/407/EEc as introduced by Commission Decision 2008/120/EC. The colour of the stamp and signature must be different from that of the other particulars in the certificate. nw 2/ 5
88/407 (2016/2008) Bovine semen D3 II. Helseinformasjon II.a. Sertifikatets referansenummer II.b. Lokalt referansenummer: Del II: Attestering Offentlig veterinær eller offentlig inspektør (med blokkbokstaver): Lokal veterinærenhet: Stempel Stilling og tittel: Den lokale veterinærenhetens nr.: Underskrift: nw 3/ 5
III.1. Kontrolldato Sertifikat til bruk ved handel innenfor Fellesskapet III.2. Sertifikatets referansenummer: III.3. Dokumentkontroll:: Nei Ja EU-standard Tilleggsgarantier Nasjonale krav III.4. Identitetskontroll: Nei Ja III.5. Fysisk kontroll:: Nei Antall kontrollerte dyr III.6. Laboratorieundersøkelser:: Nei Ja Del III: Kontroll III.7. Dyrevelferdskontroll Nei Ja III.8. Brudd på dyrevelferdsbestemmelser: III.8.1. Ugyldig transporttillatelse III.8.2. Transportmidlet oppfyller ikke kravene III.8.3. For høy lastetetthet Gjennomsnittsplass III.8.4. Transporttid ikke overholdt III.8.5. Utilstrekkelig vanning og fôring III.8.6. Uforsvarlig behandling av dyrene [nw] III.8.7.Supplementary measures for the journeys of long duration III.8.8.Certificate of proficiency of the driver [nw] III.8.9.Data registered in the log book III.8.10. Annet III.10. Konsekvenser av transporten på dyr(ene) Antall døde dyr:: Anslag: Antall uegnede dyr: Anslag: Antall dyr som har født eller abortert: III.11. Korrigerende tiltak Prøvd for:: Stikkprøve Mistanke Resultater:: Foreligger ennå ikke III.9. Brudd på helsebestemmelser III.9.1. Manglende/ugyldig sertifikat III.9.2. Ikke samsvar med dokumentene III.9.3. Ikke-godkjent land III.9.4. Ikke-godkjent region/sone III.9.5. Forbudt art III.9.6. Manglende tilleggsgarantier III.9.7. Ikke-godkjent driftsenhet III.9.8. Syke dyr eller mistanke om sykdom III.9.9. laboratoriefunn III.9.10. Manglende eller ureglementert identifikasjon III.9.11. Nasjonale krav ikke oppfylt III.9.12. Feilaktig adresse på bestemmelsesstedet III.9.14. Annet III.12. Oppfølging av karantene III.11.1. Utsatt avgang III.11.2. Overføring III.11.3. Karantene III..11.4. Slakting/avliving III.12.5. Destruering av skrotter/produkter III.12.6. Tilbakesending III.12.7. Bearbeiding av produkter III.11.8. Bruk av produkter til andre formål Identifikasjon: III.12.1. Slakting/avliving III.12.2. Frigivelse III.13. Kontrollsted Virksomhet Driftsenhet Oppsamlingssentral Lokalene til en forhandler Godkjent organ Sædstasjon Havn Lufthavn Utførselssted Under transport Annet III.14. Offentlig veterinær eller offentlig inspektør Lokal veterinærenhet (med blokkbokstaver): Stilling og tittel Den lokale veterinærenhetens nr. Underskrift: nw 4/ 5
[nw] PLANNING [nw] 1.1. ORGANISER name and address (a) (b) [nw] 1.2. Name of the person in charge of the journey [nw] 1.3. Telephone / Fax [nw] 2. TOTAL EXPECTED DURATION (hours / days) [nw] 3.1. Place and country of DEPARTURE [nw] 4.1. Place and country of DESTINATION [nw] 3.2. Date [nw] 3.3. Time [nw] 4.2. Date [nw] 4.3. Time [nw] 5.1. Species [nw] 5.2. Number of animals [nw] 5.3. Veterinary certificate(s) number(s) [nw] 5.4. Estimated total weight of the consignment (in kg) [nw] 5.5. Total space foreseen for the consignment (in m²) [nw] 6. LIST OF FORESEEN RESTING, TRANSFER OR EXIT POINTS [nw] 6.1. Name of the places where animals are to be rested, or transferred (including exit points) [nw] Date [nw] 6.2. Arrival [nw] Time [nw] 6.3. Length (in hours) [nw] 6.4. Transporter name and authorisation N (if different from the organiser) [nw] 6.5 identification [nw] 7. I, the organiser, hereby declare that I am responsible for the organisation of the above-mentioned journey and I have made suitable arrangements to safeguard the welfare of the animals throughout the journey in accordance with the provisions of Council Regulation 1/2005 [nw] 8. Signature of the organiser [nw] (a) Organiser: see definition laid down in Article 2(q) of Council Regulation 1/2005 [nw] (b) If the organiser is a transporter the authorisation number shall be specified nw 5/ 5