Del I: Opplysninger om forsendelsen

I.1. Avsender Sertifikat til bruk ved hel 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 L I.5. Mottaker I.6. Nr. på tilhørende originalsertifikat(er) Nr. på følgedokument(er) I.7. Forhler L I.8. Opprinnelsesl I.9. Opprinnelsesregion Kode I.10. Mottakerstat I.11. Bestemmelsesregion Kode I.12. Opprinnelsessted/fangststed I.13. Bestemmelsessted Driftsenhet Oppsamlingssentral Lokalene til en forhler Driftsenhet Oppsamlingssentral Lokalene til en forhler 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: Kunstig reproduksjon 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 [nw] Donor identity Innsamlingsdato(er) Mengde Type kolli nw 1/ 5

[nw] 2010/470 (2015/261) Equine semen Part C II. Helseinformasjon II.a. Sertifikatets referansenummer II.b. Lokalt referansenummer: I, the undersigned official veterinarian, hereby certify that: II.1. The semen collection centre(2), in which the semen described above was collected, processed stored for trade: II.1.1. is approved supervised by the competent authority according to the conditions of Chapter I of Annex D to Directive 92/65/EEC; II.1.2. is situated on the territory or in the case of regionalisation in a part of the territory(1) of a Member State which was on the day semen was collected until the date the semen was dispatched as fresh/chilled(1) semen or until the 30 days matory storage period for frozen semen elapsed(1) not considered to be infected with African horse sickness in accordance with Article 5(2)(a) (b) of Directive 2009/156/EC(3); Del II: Attestering II.1.3. II.1.4. II.2. II.3. II.3.1. II.3.2. II.3.3. II.3.4. II.3.5. II.3.6. [II.3.6.1. II.3.7. II.3.7.1. II.3.7.2. II.3.7.3. II.4. fulfilled during the period commencing 30 days prior to the date of semen collection until the date the semen was dispatched as fresh/chilled(1) semen or until the 30 days matory storage period for frozen semen elapsed(1), the conditions of Article 4 of Directive 2009/156/EC; contained during the period commencing 30 days prior to the date of semen collection until the date the semen was dispatched as fresh/chilled(1) semen or until the 30 days matory storage period for frozen semen elapsed(1) only equidae which were free of clinical signs of equine viral arteritis contagious equine metritis; All equidae have been admitted onto the centre under the provisions of Article 4 5 of Directive 2009/156/EC(3); The semen described above was collected from donor stallions, which: on the day the semen was collected have not shown clinical signs of an infectious or contagious disease, during at least 30 days prior to collection of the semen have not been used for natural service, during the last 30 days prior to collection of the semen have been kept on holdings where no equidae showed clinical signs of equine viral arteritis, during the last 60 days prior to collection of the semen have been kept on holdings where no equidae showed clinical signs of contagious equine metritis, to the best of my knowledge as far as I could ascertain, have not been in contact with equidae suffering from an infectious or contagious disease during 15 days immediately preceding collection of the semen, have undergone the following animal health tests, carried out in a laboratory recognised by the competent authority, in accordance with a test programme as specified in point II.3.7. an agar-gel immuno-diffusion test (Coggins test) for equine infectious anaemia with negative result;] (1)either [II.3.6.2. a serum neutralisation test for equine viral arteritis with negative result at a serum dilution of one in four; ] (1)or [II.3.6.2. a virus isolation test for equine viral arteritis carried out with negative result on an aliquot of the entire semen of the donor stallion;] II.3.6.3. an agent identification test for contagious equine metritis carried out on two occasions on samples collected from the donor stallion with an interval of seven days by isolation of Taylorella equigenitalis from pre-ejaculatory fluid or a semen sample from genital swabs taken at least from the penile sheath, urethra urethral fossa with negative result in each case; have been subject to the one of the following test programmes(4): [The donor stallion was continuously resident on the collection centre for at least 30 days prior to the semen collection, during the collection period, no equidae on the collection centre came during that time into direct contact with equidae of lower health status than the donor stallions. The tests described in point II.3.6. have been carried out on samples taken on (5) in the case of contagious equine metritis on a second sample taken on (5), being at least 14 days after the commencement of the above residence period at least at the beginning of the breeding season;] [The donor stallion was not continuously resident on the collection centre or other equidae on the collection centre came into contact with equidae of lower health status than the donor stallion. The tests described in point II.3.6. have been carried out on samples taken on (5) in the case of contagious equine metritis on a second sample taken on (5), being within the 14 days period before the first semen collection at least at the beginning of the breeding season, the test described in point II.3.6.1. for equine infectious anaemia was last carried out on a sample of blood taken on (5), being not more than 120 days before the semen described above was collected; (1)either [one of the tests described in point II.3.6.2. for equine viral arteritis was last carried out on a sample collected on (5), being not more than 30 days before the semen described above was collected,] (1)or [the non-shedder state of the seropositive stallion for equine viral arteritis was confirmed by a virus isolation test which was carried out on an aliquot of the entire semen of the donor stallion collected on (5), being not more than one year before the semen described above was collected;] ] [The tests described in point II.3.6. have been carried out during the 30 days matory storage period of frozen semen not less than 14 days after the collection of the semen on samples taken on (5) in the case of contagious equine metritis on a second sample taken on (5);] The semen described above was collected, processed, stored transported under conditions which comply with the requirements of Chapters II III of Annex D to Directive 92/65/EEC. Notes Part I: Box I.12.: Box I.13.: Box I.23.: Box I.31.: Part II: (1) (2) (3) (4) (5) place of origin shall correspond to the semen collection centre of origin of the semen. place of destination shall correspond to the semen collection or storage centre or to the holding of semen destination. identification of container 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 centre indicated in Box I.12. where the semen was collected. Delete as appropriate. Only approved semen collection centres listed in accordance with Article 11(4) of Council Directive 92/65/EEC on the Commission website: http://ec.europa.eu/food/animal/approved_establishments/establishments_vet_field_en.htm OJ L 192, 23.7.2010, p. 1. Cross out the programme(s) that do(es) not apply to the consignment. Insert date. The colour of the stamp signature must be different from that of the other particulars in the certificate. nw 2/ 5

[nw] 2010/470 (2015/261) Equine semen Part C 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 hel innenfor Fellesskapet III.2. Sertifikatets referansenummer: III.3. Dokumentkontroll:: Nei Ja EU-stard 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 behling 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 l 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 re formål Identifikasjon: III.12.1. Slakting/avliving III.12.2. Frigivelse III.13. Kontrollsted Virksomhet Driftsenhet Oppsamlingssentral Lokalene til en forhler 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 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 country of DEPARTURE [nw] 4.1. Place 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 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 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