DA-241 Sanitary Certificate Request - Algeria

OMB No.0581-0283
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 0581-0283. 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.

U. S DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

SANITARY CERTIFICATE REQUEST

Faxed Certificate
0 Additional
I acknowledse that bv checking this box that the information provided is factual and accurate.
1. CONTACT NAME
2. AMS BILLING ACCT.

3. BILLING REFERENCE

4. E-MAIL

ADDRESS

11. STATE

5. CONTACT PHONE
CONSIGNOR

15. C|TY/STATE
CONSIGNEE

18. COUNTRY CODE

DZ

IDENTIF!CATION OF DAIRY PRODUCTS

19. DESCRIPTION OF COMMODITY
20. NUMBER OF PACKAGING UNITS
21. NET WEIGHT
22. GROSS WEIGHT

23. DATE PRODUCED
24.LOT NUMBER
MANUFACTURER

25. PLANT NUMBER

SHIPMENT INFORMATION

26. DEPARTURE PORT
28. TRANSPORT NAME/VOYAGE NUMBER
SIGNATURE (for faxed or moiled copies)

**For fastest processing, please attach this form and a
DA-247

PDF

shipping label in an email to [email protected].

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