Del I: Opplysninger om forsendelsen

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 I.9. Opprinnelsesregion Kode I.10. Mottakerstat 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 I.25. Dyr sertifisert til / produkter sertifisert til: [nw] Production Avl Slakting Godkjente organer Kunstig reproduksjon Kjæledyr I.26. Transitt gjennom tredjestat I.27. Transitt gjennom medlemsstater Utførselssted Kode Innførselssted GKS-nr. I.28. Eksport I.29. Forventet transporttid Utførselssted Kode I.30. Reiseplan Ja Nei I.31. Identifikasjon av dyrene Art Identifikasjonsmetode Identifikasjonsnummer Passnummer Alder Mengde Kjønn (hunn, hann, kastrert) nw 1/ 5

[nw] 92/65 (2013/518) EI Animals from holdings (ungulates, birds(2), lagomorphs, dogs, cats and ferrets) II. Helseinformasjon II.a. Sertifikatets referansenummer II.b. Lokalt referansenummer: Del II: Attestering (1)(2)or I, the undersigned official veterinarian(1) / veterinarian responsible for the establishment of origin and approved by the competent authority(1) certify that: II.1. the animals described in Box I.31 comply with the conditions of Article 4 of Council Directive 92/65/EEC and at the time of inspection were fit to be transported for the intended journey in accordance with the provisions of Council Regulation (EC) No 1/2005. ruminant(s) (1)/ suidae (1) other than that /those covered by Council Directive 64/432/EEC (1) or Council Directive 91/68/EEC (1): (a) belong(s) to the species ; (b) at the time of examination, do(does) not show any clinical sign of any disease to which it/they is /are susceptible; (c) come(s) from an officially tuberculosis-free (1)/ officially brucellosis-free (1) or brucellosis-free (1) herd (1)/ holding (1) not subject to swine fever restrictions or from a holding where it/they was/were subjected with negative results to the tests laid down in Article 6(2)(b) (1)/ the test laid down in Article 6(3)(d) (1) of Council Directive 92/65/EEC.] the birds other than those referred to in Council Directive 2009/158/EC (a) at the time of examination do not show any clinical sign of any disease to which they are susceptible; (b) satisfy the requirements of Article 7 of Council Directive 92/65/EEC; (c) conform to Commission 2007/598/EC and were vaccinated against avian influenza on (date) with vaccine (name) and come from a holding on which vaccination against avian influenza was carried out during the past 12 months.] the lagomorphs (a) at the time of examination do not show any clinical signs of disease to which they are susceptible; (b) satisfy the requirements of Article 9 of Council Directive 92/65/EEC.] the dogs [(c) were at least 12 weeks old at the time of vaccination against rabies and at least 21 days have elapsed since the completion of the primary anti-rabies vaccination carried out in accordance with the validity requirements set out in Annex III to Regulation (EU) No 576/2013 of the European Parliament and of the Council, and any subsequent revaccination was carried out within the period of validity of the preceding vaccination]] ; [(c) are less than 12 weeks old and have not received an anti-rabies vaccination, or are between 12 and 16 weeks old and have received an anti-rabies vaccination, but 21 days at least have not elapsed since the completion of the primary vaccination against rabies carried out in accordance with the validity requirements set out in Annex III to Regulation (EU) No 576/2013 of the European Parliament and of the Council], and (i) (1)and the Member State of destination has informed the public in accordance with point (b) of Article 37(2) of Regulation (EU) No 576/2013 of the European Parliament and of the Council that it authorises the movement of such animals into its territory; and they are accompanied by a declaration of the owner(3), attached to this certificate, stating that from birth until the time of dispatch the animals have had no contact with wild animals of species susceptible to rabies] ; their mother, on whom they still depend, and from the passport of their mother, it can be established that the mother received before their birth an anti-rabies vaccination which complied with the validity requirements set out in Annex III to Regulation (EU) No 576/2013 of the European Parliament and of the Council] ;] ; (d) are accompanied by a passport drawn up in accordance with Commission Implementing Regulation (EU) No 577/2013; [(e) due to their scheduled destination indicated in Box I.10 or in Box I.11 where regionalisation is applied, have been treated against Echinococcus multilocularis in accordance with Commission Delegated Regulation (EU) No 1152/2011] ] ; the cats (1)/ ferrets (1) [(c) were at least 12 weeks old at the time of vaccination against rabies and at least 21 days have elapsed since the completion of the primary anti-rabies vaccination carried out in accordance with the validity requirements set out in Annex III to Regulation (EU) No 576/2013 of the European Parliament and of the Council, and any subsequent revaccination was carried out within the period of validity of the preceding vaccination] ; [(c) are less than 12 weeks old and have not received an anti-rabies vaccination, or are between 12 and 16 weeks old and have received an anti-rabies vaccination, but 21 days at least have not elapsed since the completion of the primary vaccination against rabies carried out in accordance with the validity requirements set out in Annex III to Regulation (EU) No 576/2013 of the European Parliament and of the Council], and II.3. (i) the Member State of destination has informed the public in accordance with point (b) of Article 37(2) of Regulation (EU) No 576/2013 of the European Parliament and of the Council that it authorises the movement of such animals into its territory; and they are accompanied by a declaration of the owner(3), attached to this certificate, stating that from birth until the time of dispatch the animals have had no contact with wild animals of species susceptible to rabies] ; their mother, on whom they still depend, and from the passport of their mother, it can be established that the mother received before their birth an anti-rabies vaccination which complied with the validity requirements set out in Annex III to Regulation (EU) No 576/2013 of the European Parliament and of the Council] ;] (d) are accompanied by a passport drawn up in accordance with Commission Implementing Regulation (EU) No No 577/2013.] the dogs (1)/ cats (1)/ ferrets (1) are destined for a body, institute or centre described in Box I.13 and approved in accordance with Annex C to Council Directive 92/65/EEC, and (c) are accompanied by a passport drawn up in accordance with Commission Implementing Regulation (EU) No 577/2013.] The additional guarantees regarding diseases listed in Annex B(4) to Council Directive 92/65/EEC are as follows:(1) Blue Tongue (BT) : exemption from the exit ban nw 2/ 5

[nw] 92/65 (2013/518) EI Animals from holdings (ungulates, birds(2), lagomorphs, dogs, cats and ferrets) II. Helseinformasjon II.a. Sertifikatets referansenummer II.b. Lokalt referansenummer: Del II: Attestering Animals in compliance with Article 7(1) or 7(2)(a) or 7(2)(b) or 7(2)(c) or 7(2a)(a) or 7(2a)(b) or 7(2a)(c), (indicate as appropriate) of Regulation (EC) No 1266/2007. Animals in compliance with Article 8(1)(a) or 8(1)(b) or 8(4) or 8(5a),(indicate as appropriate) of Regulation (EC) No1266/2007. Insecticide/repellent treatment with (insert name of the product) on (insert date) in conformity with Regulation (EC) No 1266/2007. Animal(s) in compliance with Article 9a(1) of Regulation (EC) No 1266/2007 Animal(s) were kept until dispatch in a bluetongue seasonally-free zone during the seasonally vector-free period that started on (insert date) since birth or for at least 60 days and, if appropriate (indicate as appropriate), were then subjected to an agent identification test according to the OIE Terrestrial Manual on samples taken within seven days prior to dispatch, with negative results, in conformity with Annex III.A(1) to Regulation (EC) No 1266/2007. Animal(s) in conformity with Annex III.A(2) to Regulation (EC) No 1266/2007 Animal(s) in conformity with Annex III.A(3) to Regulation (EC) No 1266/2007 Animal(s) in conformity with Annex III.A(4) to Regulation (EC) No 1266/2007 Animal(s) vaccinated against bluetongue serotype/s (insert serotype/s) with (insert name of the vaccine) with a inactivated / modified live vaccine (indicate, as appropriate) in conformity with Annex III.A(5) to Regulation (EC) No 1266/2007. Animal(s) subjected to a serological test according to the OIE Terrestrial Manual to detect antibodies against the bluetongue virus serotype (indicate serotype) in conformity with Annex III.A(6) to Regulation (EC) No 1266/2007. Animal(s) subjected to a specific serological test according to the OIE Terrestrial Manual to detect antibodies against all the bluetongue virus serotypes (indicate serotypes) present or likely to be present in conformity with Annex III.A(7) to Regulation (EC) No 1266/2007. "Animal(s) is (are) not pregnant" or "Animal(s) may be pregnant and complies (comply) with the condition(s) point 3 ; indicate as appropriate)". (set out in points 5, 6 and 7 before insemination or mating or set out in Notes Part I: Box I.6.: Box I.19.: Box I.31.: No(s) of accompanying documents: CITES, if applicable. Use the appropriate CN code: 01.06.19, 01.06.31, 01.06.32, 01.06.39. Identification system: individual identification must be used wherever possible but in the case of small animals, batch identification may be used. In the case of dogs, cats and ferrets, select passport. Identification number: in the case of dogs, cats and ferrets, indicate the alphanumeric code of the tattoo or transponder. Passport number: in the case of dogs, cats and ferrets, indicate the unique alphanumeric code of the passport. Part II: (1) (2) (3) Delete as necessary. Certification requirements only apply to birds that have been vaccinated against avian influenza under a preventive vaccination plan approved by Commission 2007/598/EC. The declaration referred to in point II.2 to be attached to the certificate shall be drawn up in accordance with the model set out in Annex I to Commission Implementing Regulation ((EU) No 577/2013. (4) As requested by a Member State benefiting from additional guarantees under Union legislation. The colour of the stamp and signature must be different from that of the other particulars in the certificate. This certificate is valid for 10 days from the date of signature of the official veterinarian or of the veterinarian responsible for the holding of origin and approved by the competent authority. 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