VS 17-129 Fish Import Permit Application

No animals, animal semen, animal embryos, birds,
poultry, or hatching eggs may be imported unless a
completed application has been received (9 CFR 92
and CFR 93.)

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0040.
The time required to complete this information collection is estimated to average 2 hours per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information.

FORM APPROVED OMB NO. 0579-0040

1. NAME AND ADDRESS OF SHIPPER IN COUNTRY OF ORIGIN

U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

APPLICATION FOR IMPORT OR IN TRANSIT PERMIT
(Animals, Animal Semen, Animal Embryos, Birds, Poultry, or Hatching Eggs)
INSTRUCTIONS TO IMPORTER: Complete and submit one copy to the Veterinary Services,
APHIS, U.S. Department of Agriculture, 4700 River Road, Riverdale, MD 20737. Prepare a
separate application for each shipment.
2. NAME AND ADDRESS OF IMPORTER (Include Area Code)

3. PORT OF EMBARKATION (From Canada show only for ocean vessel
or airplane shipments)

4. COUNTRY FROM WHICH SHIPPED

5. MODE OF TRANSPORTATION (Name of Airline or Vessel, flight no.)
TELEPHONE NUMBER (Include Area Code)

6. ANIMALS, ANIMAL SEMEN, ANIMAL EMBRYOS, BIRDS, POULTRY, OR HATCHING EGGS
A.

NO.

B.

BREED

C.

SPECIES

D.

DESCRIPTION
(Sex, Age, Registered Name and No., Tattoo, Tag No., other Markings)

6E. PURPOSE OF IMPORTATION

7. ROUTE OF TRAVEL INCLUDING ALL CARRIER STOPS ENROUTE (From Canada show route of travel only for ocean vessel or airplane shipment)

8. PROPOSED SHIPPING DATE (From Canada show only for ocean
vessel or airplane shipment)

9. PROPOSED ARRIVAL DATE

11. NAME AND MAILING ADDRESS OF PERSON TO WHOM DELIVERY WILL BE
(After quarantine, when required) (Include Zip Code)
MADE

10. UNITED STATES PORT OF ENTRY

12. WHERE DELIVERY WILL BE MADE IN U.S. (After quarantine, when
required) (Location of place)

TELEPHONE NUMBER (Include Area Code)

13. REMARKS

14. SIGNATURE OF IMPORTER

VS FORM 17-129 (DEC 2002) Previous edition may be used.

15. DATE SIGNED