Part I : Details of dispatched consignment

28.6.2013 Official Jou al of the European Union L 178/143| EN

ANNEX IV

PART 1

Model animal Health certificate for the non-comtnerdal movement into a Memher State Irom a territory or thirdcountry of dogs, c ts or ferrets in accordance with Article 5(1) and (2) of Regulation (EU) No 576/2013

COUNTRY: Veterinary certificate to EU

1.1. ConslgnorName

1.2. Certificate reference No

Address

Tel.

i.3. Central competent aufhority

1.4. Local competent authority

I.5. ConsigneeNameAddress

1.6.

Postal codeTel.

I.7. Country of ISO code I.8.origin '

1.10.

i .

1.13.

1.12.

1.14.

1.15. 1.16.

'¦1

1.18. Description of co modlty 1.18. Commodity code (HS code)010619

1.20, Quantity

1.25. Commodities certified for:

Pets

1.28. Identification of the Commodities

Species(Scientific name)

Sex Identification Colour Breed Date of appiication and/or reading of Identification Date of birthSystem the transponder or tattoo nu ber [dd/mm/yyyy]

[dd/mm/yyyy]

Part II: Certification

L 178/144 EN Official Jou al of the European Union 28.6.2013

Non-commercial movement into a Member State from a territory orttiird country of dogs, cats or ferrets in accordance with Article 5(1)

COUNTRY a (2) of Regulation (EU) No 576/2013

II. Health Information ll.a. Certificate reference No

I, the undersigned offioial veterinarian (1)/veterinarian authorised by the competent authority(1) of ..of territory or third country) certify that:

Purpose/nature of Journey attested by the owner:

11.1. the attaohed declaration f2) by the owner or the natural person who has a thorisation in writing from the owner to carry outthe non-commercial movement of the animals on behalf of the owner, supported by evidence (3), States that the animalsdescribed in Box 1.28 will acoompany the owner or the natural person who has authorisation in writing from the o ner tocarry out the non-commercial movement of the animals on behalf of the owner wlthln not more than five days of hismovement and are not subject to a movement that aims at their sale or a transfer of o nership, and during the non-com ercial movement will remain under the responsibillty of

( ) either [the owner;]

(1) or [the natural person who has authorisation in writing fro the owner to carry out t eanimals on behalf of the owner;]

non-commercial movement of the

(1) or [the natural person designated by a carrier contracted by the owner to carry out theanimals on behalf of the owner;]

non-commercial movement of the

(1) either [II.2. the animals described in Box 1.28 are mo ed in a number of five or less;]

(1) or [II.2. the animals describe in Box 1.28 are moved in a number of more than five, are more than six months old and are going topartioipate in oom etitions, e hibitions or sportin events or in t alnlng for those events, and the owner or the naturalperson referred to in point 11.1 has provided e idence (3) that the animals are registered

t1) either [to atten such event;]

(1) or [with an association organising such events;]

Attestation of rabies vaooination and rabies anti ody titration test:

( ) either [II.3. the animals described in Box 1.28 are less than 12 weeks old and have not received an anti-rabies vaccination, or arebetween 12 and 16 v/eeks old and have received an anti-rabies vaccination, but 21 days at least have not eiapsed sincethe com letion of the primary vaccination against rabies carried out in accordance with the validity requirements set out inAnnex III to Regulation (EU) No 576/2013 (4), and

11.3.1 the territory or third country of provenance of the animals indicated in Box 1.1 Is listed in Annex II to CommissionImplementing Regulation (EU) No 577/2013 and the Member State of destlnatlon indicated in Box 1.5 has informedthe public that it authorises the movement of such animals into Ifs territory, and they are accom anied by

( ) either [11.3.2 the attaohed declaration (5) of the owner or t e natural person referre to in point 11.1 stating that from birth until thetime of the non-commercial move ent the animals have ad no oontaot with wild animals of species susoeptible torab es;].

(1) or [11.3.2 their mother, on who they still depend, and it can be established that the other received before their birth ananti-rabies vaccination hich complied with the validity requirements set out in Annex III to Regulation (EU) o5 6/2013;].

{') or/and [II.3. the animals described in Bo 1,28 were at least 12 weeks old at the time of vaccination against rabies and at least 21 dayshave eiapsed since t e co pletion of the primary anti-rabies accination (4) carried out in accordance ith the vali ityrequirements set out in Anne III to Regulation (EU) No 576/2013 an any subsequent revacoination was carried out withlnthe period of val dity of the preceding vaccination (6); and

(1) either [11.3.1 the animals described in Box I.28 oome from a territory or a third countty listed in Anne II to ImplementingRegulation (EU) No 577/2013, either directly, throug a territory or a third country listed in Annex II to ImplementingRegulat on (EU) No 577/2013 or through a territory or a third country other than those listed in Annex II toImplementing Regulation (EU) No 577/2013 in accordance with point (c) of Article 12(1) of Regulation (EU) o576/2013 (7), and the details of the c rrent anti-rabies vaccination are provided in the table below;]

I1) or [11.3.1 the ani als described in Box I.28 come from, or. are soheduled to transit through, a territory or third country otherthan those listed In Anne II to Commission Implementing Regulation (EU) No 577/2013 and a rabies antibo ytitration test (8), carried out on a blood sample taken by the veterinarian authorised by the competent authority o the date indicate in the table below not less than 30 ays after the preceding vaccination and at least threemonths prior to the date of issue of this certificate, proved an antibody titre equal to or greater than 0,5 lU/ml andany subsequent re acoination was carried o t within the period of validity of the preceding vaccination (6), and thedetails of the current anti-rabies vaccination an the date of samplin for testing the immune response are providedin the table below:

28.6.2013 Official Journal of the European Union L 178/145r®n

Non-commercial movement into a Member State from a territory orthird country of dogs, cats or ferrets ln accordance with Article 5(1)

COUNTRY an (2) of Regulation (EU) No 576/2013

II. Health Information ll.a. Certificate,reference No

Transponder or tattooalphanumeric code of

the animal

Date of vaccination[d /mm/yyyy]

Name andmanufacturer of vacclne Batch number

Validity of vaccinatlonDate of the blood

samplin [dd mm/yyyy]From

[ d/ m/yyyy]to

' [dd/mm/yyyy]

Attestation of anti-parasite treatment:

(1) either [II.4. the dogs described in Bo I.28 are destined for a Me ber State listed in Annex I to Commission DelegatedRegulation (EU) No 1152/2011 and have been treated aga nst Echinococcus multiloc laris, and the details of thetreatment carried out by the admlnistering veterinarian in accordance with Article 7 of Commission DelegatedRegulation (EU) No 115 /2011 (9)(10)(11) are rovided in the table below.]

(') or [II-4. the do s described in Box I.28 ha e not been treated against Echinococcus multilocularis (11).]

Transponder or tatloo number of theog

Anti-echlnococcus treatment Admlnistering veterinarian

Name an manufacturer of the product Date [dd/mm/yyyy] and ti e of treatment[00:00] Name In capitals, stamp and Signatare

Notes

(a) This certificate is meant for dogs (Canis lupus fam iaris), cats (Felis siiveslris catus) and ferrets (Mustela putorius furo).

(b) This certificate is valid for 10 days from the dato of tssue by the officia! veterinarian until the date of the documentary an identit checks at theesignate Union travellers' po nt of entry (available at http://ec.europa.eu/food/animal/Iiveanimals/pets/pointsentry_en.ht ).

In the case of transport by sea, thatperiod of 10 ays is extended by an additional period corres onding to the duration of the journey by sea,

For the purpose of further movement into other Member States, this certificate is valid from the date of the ocumentary and identity checks fora total of fo r months or until the date of expiry of the alidity of the anti-rabies vaccinatlon or until the conditions relating to animals less than16 weeks ol referred to in point 11,3 cease to apply, whlchever date is earlier. Please note that certain ember States have informed that themovement into thelr territory of animals less than 16 weeks old referred to in point II.3 is not authorised. You may wish to inquire athttp://ec.euro a.eu/food/anlmal liveanimals/pets/inde _en.htm

Part 1;

Box 1.5: Conslgnee: in icate ember State of first destination.

Box 1.28: Identification System: select of the foliowing: transponder or tattoo.

In the case of a trans onder. select date of application or reading.

In the case of a tattoo: select date of application and reading. The tattoo must be clearly readable and applie before 3 July 2011.

Identification number: indicate the transponder or tattoo alphanumeric code.

Date of birth/breed: as stated by the owner.

L 178/146 I EN | Official Journal of tfae Europe n Union • 28.6.2013

COUNTRY

Non-commercial movement into a Me ber State trom a territory orthird countr of dogs, cats or ferrets in accordance with Article 5(1)and (2) of Regulation (EU) No 576/2013

II. Health Information II.a. Certificate reference No

Part II:

(1) Keep as appropriate.

(2) The declaration referred to in point 11.1 shall be attached to the certificate and comply with the model and additional requirements set out inPart 3 of Annex IV to Implementing Regulation (EU) No 577/2013.

(3) The evidence referred to in oint 11.1 (e.g. boarding pass, flight ticket) and in point II. 2 (e.g, receipt of entry to the event, proof of membership)shall be surrendered on request by the competent authorities responslble for the checks referred to in point (b) of the Notes.

(4) Any revaccination must be considered a primary vacoination if it was not carrie out within the period of validity of a previous vaccination.

(5) The declaration referred to n point 11.3.2 to be attached to the certificate complles with the formal, layout and language requirements laiddown in Parts 1 and 3 of Annex I to Implementing Regulation (EU) No 577/2013.

(6) A certlfled copy of the Identification and vaccination details of the animals concerned shall be attached to the certificate.

(7) The third Option is subject to the condition that the owner or the natural person referred to in point 11.1 pro ides, on request by the competentauthorities responsibie for the checks referred to in point (b), a eclaration statin that the animals have ha no contaot with ani als ofspecies susceptible of rabies and remain secure within the means of transport or the perimeter of an international airport during the transitthrough a territory or a third countr other than those listed in Annex II to Implementing Regulation (EU) No 577 2013. This declaration shallcomply ith the formal, layout an language requirements set out in Parts 2 and 3 of Anne I to Implementing Regulation (EU) No 577/2013.

(8) The rabies antibody titration test referred to in point 11.3.1:

must be carried out o a sam le oollected by a veterinarian author se by the competent author ty, at least 30 ays after the date ofvaccination and three onths before the date of Im ort;

ust measure a level of neutralising antibody to rabies virus in serum equal to or greater than 0,5 lU/ml;

must be performed by a laboratory approved in accor ance with Article 3 of Council Declsion 2000/258/EC (list of appro ed laboratoriesavailable at http://ec.euro a.eu food/animai/liveanimals/pets/approval_en.htm);

does not ha e to be renewed on an animal, hich foiiowing that test with satisfactory results, has been revaccinated against rabies withinthe eriod of validity of a previous vaccination.

A certified oopy of the official report from the a proved laboratory on the results of the rabies antibody test referred to in point 11.3.1 shall beattached to the certificate.

(9) The treatment against Echinococcus multilocularis referred to in point II.4 must:

be administered by a veterinarian within a perio of not more than 120 hours and not lass t an 24 hours before the time of the scheduledentry of the dogs into one of the Member States or parts thereof listed In Annex I to Delegated Regulation (EU) No 1152/2011;

consist of an ap roved me icinal product which contains the appropriate dose of praziquantel or pharmacologicall aotive substanoes,which alone or in combination, have been proven to re uce the bürden of mature an immature intestinal forms of Echinococc smultilocularis in the host species concerned.

(10) The table referred to in point II.4 must be used to document the details of a further treatment if administered after the date the certificate wassigned and prior to the scheduled entry into one of the Member States or parts thereof listed in Annex I to Delegate Reg lation (EU) No1152/2011.

(,1) The table referred to in point II.4 must be used to document the details of treatments if a ministered after the date the certificate was signedfor the purpose of further movement into other ember States desoribed in point (b) of the otes and in conjunction wit footnote (9).

28.6.2013 Hin Official Journal of the Eu opean Union L 178/147

Non-commercial movement into a Member State from a territory orthird country of dogs, cats or ferrets in accordance with Article 5(1)

COUNTRY and (2) of Regulation (EU) No 576/2013

II. Health Information II ,a. Certificate reference No

Official veterinarian/Authorised veterinarian

Name (in Ca ital letters):

Address

Telephone:

Date:

Stamp:

Qualificatlon and title:

Si nature:

En orsement by the competent authority (not necessary when the certificate is signed by an official veterinarian)

ame (in Capital letters): Qualificatlon and title:

A dress

Telephone:

Date: Signature:

Stamp:

Official at the travellers' point of entry (for the purpose of further movement into other Member States)

Name (In Capital letters): Title:

Address

Telephone:

E-mail address:

Date of completion of the documentary and Identity checks: Si nature: Stamp:

PART 2

Explanatory notes for completing the animal Health certificates

(a) Where the certificate States that cettain Statements shall.be ke t as a pro riate, Statements which are not relevant mayhe erossed out and initialled and stampe by the official veterinarian, or completely deleted from the certificate.

(b) The original of each certificate shall consist of a single sheet of aper, or, where tnore text is required it must be insuch a form that all sheets of pa er required are pari of an integrated whole and indivisible.

(c) The certificate shall be rawn u in at least one of the official langua es of the Member State of entry and in English.It shall be completed in block letters in t least one of the official lan uages of the Member State of entry or inEnglish.

(d) If a itional sheets of paper or sup orting documents are attached to the certificate, those sheets of paper o ocument shall also be conside ed as for in patt of the original of the certificate by the application of the

signature and stamp of the officialrveterinarian, on each of the pa es.

(e) When the certificate, includin additional sheets referred to in point (d), comprises more than one page, each ageshall be numbered (page number of total number of pages) at the en of the page and shall bear at the top of eachpage the certificate reference number that has been designated by the competent authorit .

(f) The ori inal of the certificate shall be issue b an official veterinarian of the tenitory or thü country of dis atch o by an authorise veterinarian and subsequently endorse by the competent authorit of the territory or third countryof is atch. The competent authority of the territor or third countiy of dispatch shall ensure that rules and principlesof ertification equivalent to those laid down in Directive 96/93/EC are follo ed.

he colour of the si nature shall be different from that of the prinüng. This re uirement also applies to stamps otherthan those embossed or watermarke .

L 178/148 I EN 1 Official Jou al of the European Union 28.6.2013

(g) The certificate reference number refened to in Boxes 1.2 and Il.a shall be issued by the competent authorit of theterritory or third country of dispatch.

PART 3

ritten eclaration referred to in Article 25(3) of of Regulatio (EU) No 576/2013

Sectio A

Mo el of declaration

I, the undersigned

[owner or the natural person who has authorisation in writing from the owner to carry out the non-commercial movement onbehalf of the owner (')]

declare that the following pet animals are not subjeot to a ovement that alms at their sale or a transfer of ownership andwill accompany the owner or the natural person who has authorisation in writing fro the o ner to carry out the non-co ercial movement on behalf of the owner/1) within not more than five days of his move ent.

TransponderAattoo (1) aJp anumeric co e Anima! health certificate number

Düring the non-commercial move ent, the above ani als will remain under the responslbility of

(1) eilher (the owner];

( ) or [the natural person who has authorisation in writing from the owner to carry out the non-co ercial move enton behalf of the owner]

(1) or [the natural person designated by the carrier contracted to carry out the non-commercial ovement on behalfof the owner: [inseii name of the carrieh)]

Place and date:

Si natare of the owner or natural person who has authorisation in writin from the o ner to carry out the non-commercialmovement on behalf of the owner f1):

(') Delete as approprlate.

Seclion B

A ditional requirements for the declaration

The declaration shall be rawn up in at least one of the official language(s) of the Membef State of entry and in Englishand shall be com leted in block letters.