9060-6 Application for Export Certificate

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U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE

APPLICATION FOR EXPORT CERTIFICATE
FOR

MEAT, POULTRY AND EGG PRODUCTS

APPLICATION
Original Application
Amended Application
Export Certificate No.

Shipment Type

Reason for Amended or In Lieu of Application
Lost or Damaged Certificate
Other (Please explain)
Establishment Name:

Commercial Sale
Personal Consumption
Samples
Ship’s Stores
U.S. Military Installation
Establishment Number:

EXPORTER (Consignor)
Establishment No.
Company Name
Street Address
City
State
Zip Code

IMPORTER (Consignee)
Company Name
Address Line1
Address Line2
Country

EXPORT INFORMATION
District Office
Country of Destination
Product Exported from Est. No.
Facility Name
Type of Plant
City, State

WEIGHT MANAGEMENT
Metric Weight Conversion
Weight (No. of Decimal Places)

TOTAL WEIGHT
Total Marked Net Weight
Total Containers

FSIS Form 9060-6 ( 03/04/2011) PREVIOUS EDITIONS OBSOLETE

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PRODUCT INFORMATION
Est. No. on Product
Processing/Packing Est. No. **
Slaughter Est. No **
ID Warehouse Est. No. **
Product Code
Prefix for Product as Labeled
Product As Labeled
Marked Weight of Lot
Weight Unit of Measure
No. of Packages in Lot
Type of Packaging
Shipping Marks
Stamp Choice
USDA Stamp
Company Stamp
Lot Identification
Slaughter Date(s)
Processing or Packing Date(s)
Expiration Date(s)
Eggs Laid-on Date(s)

INFORMATION FOR STATEMENTS/LETTERHEAD CERTIFICATES
Animal Health Import Permit No.
Casings Company Est. No.
Casings Company Name
Casing Company Address Line 1
Casing Company Address Line 2
Grade
MAFF Health Certificate No.
Manufacturer
Official Meat Inspection Cert. No.
Ruminant Species
Sterilization Degrees
Sterilization Minutes
Tested For
Test Results

FSIS Form 9060-6 ( 03/04/2011) PREVIOUS EDITIONS OBSOLETE

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METHOD OF TRANSPORTATION AND EXPORTING CARRIER**

Rail

Air

Vessel

Truck

Vessel Name
Voyage Number
Airline Name
Flight Number

SHIPMENT INFORMATION**
Transportation Reference No.
Port of Export
Shipping Date
Declared Port of Entry/Border Crossing

CONTAINER AND SEAL NUMBER INFORMATION**
Container Number
Seal Number
Seal Type

NATIONAL TRANSPORTATION OF LIVE ANIMALS AND THEIR PRODUCTS**
U.S. State
County

INTERNATIONAL TRANSPORTATION OF EXPORTED PRODUCTS**
Country
Port Type

**= Required based on the exporting country requirements
NUMBER OF ATTACHMENTS:

A knowingly false entry or false alteration of any entry on this certificate may result in a fine of not more than $10,00 or imprisonment of not more
than five years or both (18 USC 1001). Additionally penalties exist under the Federal Meat Act [21 USC 611 (b) (1), (2), and (5). 21 USC 676] and
the Poultry Products Inspection Act [21 USC 458 (c) (1), (2), and (5), 21 USC 461] and the Egg Products Inspection Act [21 USC 1037 (e) (2), (3),
and (6), 21 USC 1041] for an unauthorized or false alteration or misuse of this certification.

SIGNATURE:

PRINTED NAME:

DATE:

Under penalty of law, I certify that the product covered by this application for export meets the inspection requirements for
the country of destination. I will provide documentation to FSIS program employees upon request.
FSIS Form 9060-6 ( 03/04/2011) PREVIOUS EDITIONS OBSOLETE

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