Form PPQ 577 PPQ 577 Phytosanitary Certificate

See reverse for additional OMB information.

No phytosanitary certificate can be issued until an application is completed (7 CFR 353)

FORM APPROVED
OMB NO. 0579-0052DQG
EXP: XX/XXXX

FOR OFFICIAL USE ONLY

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE

PLACE OF ISSUE

PHYTOSANITARY CERTIFICATE
NO.:

TO: THE PLANT PROTECTION ORGANIZATION(S) OF

FPC

DATE INSPECTED

CERTIFICATION
This is to certify that the plants, plant product or other regulated articles described herein have been inspected and/or tested according to appropriate official
procedures and are considered to be free from the quarantine pests, specified by the importing contracting party and to conform with the current
phytosanitary requirements of the importing contracting party including those for regulated non-quarantine pests.
DISINFESTATION AND/OR DISINFECTION TREATMENT
1. DATE

2. TREATMENT

3. CHEMICAL (active ingredient)

4. DURATION AND TEMPERATURE

5. CONCENTRATION

6. ADDITIONAL INFORMATION

DESCRIPTION OF THE CONSIGNMENT
7. NAME AND ADDRESS OF THE EXPORTER

8. DECLARED NAME AND ADDRESS OF THE CONSIGNEE

9. NAME OF PRODUCE AND QUANTITY DECLARED

10. BOTANICAL NAME OF PLANTS

11. NUMBER AND DESCRIPTION OF PACKAGES

12. DISTINGUISHING MARKS

13. PLACE OF ORIGIN

14. DECLARED MEANS OF CONVEYANCE

15. DECLARED POINT OF ENTRY

WARNING: Any alteration, forgery, or unauthorized use of this phytosanitary certificate is subject to civil penalties of up to $250,000 (7 U.S.C. Section 7734(b)) or punishable by a
fine of not more than $10,000, or imprisonment of not more than 5 years, or both (18 U.S.C. Section 1001).

ADDITIONAL DECLARATION

16. DATE ISSUED

17. NAME OF AUTHORIZED OFFICER (Type or Print)

18. SIGNATURE OF AUTHORIZED OFFICER

No liability shall attach to the United States Department of Agriculture or to any officer or representative of the Department with respect to this certificate.
PPQ FORM 577

FEB 2001

Previous editions are obsolete after 6/30/01

According to the Paperwork Act of 1995, an agency may not conduct or sponsor, and a person is
not required to respond to, a collection of information unless it displays a valid OMB control
number. The valid OMB control numbers for this information collection is 0579-0052 and 0240.
The time required to complete this information collection is estimated to average 1.20 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.