Sanitary Certificate Request - Brazil

Export Health Certificate Request Forms

Sanitary-Brazil 100112

Export Certificates

OMB: 0581-0283

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Form Approved OMB No. 0581-NEW


U. S DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

SANITARY CERTIFICATE REQUEST-BRAZIL


According to the paperwork reduction 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. This valid OMB control number for this collection is 0581-NEW. The time required to complete this information collection is estimated to average 12 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection information.

I acknowledge that by checking this box that the information provided is factual and accurate.

  1. CONTACT NAME

     

MAIL CERTIFICATE TO:

  1. CUSTOMER NUMBER

     

7. COMPANY

     

  1. BILLING REFERENCE

     

8. CONTACT

     

  1. E-MAIL ADDRESS

     

9. STREET

     

  1. CONTACT PHONE

     

10. CITY

     

  1. FAX

     

11. STATE

     

12. ZIP

     

EXPORTER

13. NAME

     

14. ADDRESS

     

15. CITY, STATE

     

IDENTIFICATION OF DAIRY PRODUCTS

16. DESCRIPTION OF COMMODITY

     

17. DATE OR PERIOD OF PRODUCTION

     

18. LOT NUMBER

     

19. NUMBER OF PACKAGING UNITS

0

20. NET WEIGHT

     

21. IDENTIFICATION MARKS

     

MANUFACTURER

22. PLANT NUMBER

     ;      ;      

DESTINATION

23. EXPORTER NAME

     

24. EXPORTER ADDRESS

     

25. NAME OF RECEIVER

     

26. CONSIGNEE ADDRESS

     

27. PLACE OF LOADING

     

28. PLACE OF DESTINATION

     

29. SIGNATURE OF AGENT FOR APPLICANT




30. DATE

     


The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKen Vorgert Chief, Dairy Grading BranchUSDA
File Modified0000-00-00
File Created2021-01-24

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