FSIS 9060-6 Application for Export Certificate

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. The valid OMB control number for this information collection is 0583-0094. The time required to complete this information collection is estimated to average
20 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 of information.
U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE

APPLICATION FOR EXPORT CERTIFICATE
3. CERTIFICATE NO.

APPLICATION TYPE
1.

ORIGINAL

2.

REPLACEMENT APPLICATION / REASON FOR REPLACEMENT
LOST CERTIFICATE

IMPORTING COUNTRY BORDER CLOSURE

INCORRECT CERTIFICATE

SPLIT SHIPMENT

IMPORTER/EXPORTER CHANGED

CONSOLIDATED SHIPMENT

4. SHIPMENT TYPE
COMMERCIAL SALE
PERSONAL
CONSUMPTION
SHIP'S STORE

CERTIFICATE MISSING REQUIRED INFORMATION
5. DATE OF REQUEST (mm/dd/yyyy)

6. COUNTRY OF DESTINATION

U.S. MILITARY
SAMPLES
U.S. EMBASSY

7. COUNTRY OF FINAL DESTINATION

8. CONSIGNOR/EXPORTER (Applicant's name and address)

9. CONSIGNEE/IMPORTER (name and address)

10. EXPORT EST. NO.

11. EXPORT MARK TO BE USED:
USDA EXPORT MARK
UNIQUE IDENTIFIER

12.
DESCRIPTION OF PRODUCT
(including Product Code)

13.
HACCP
CATEGORY

14.
SPECIES

15.
16.
MATURITY FROZEN/
LESS
SHELFTHAN
STABLE
30 MOS.

17.
NET
WEIGHT
OF LOT

18.
NO. OF
PACKAGES
IN LOT

19.
TYPE
OF
PACKAGES
IN LOT

20.
SHIPPING/
IDENTIFICATION
MARKS

21.
EST. NO.
ON
PRODUCT

23. TOTAL NO. OF PACKAGES

22. TOTAL NET WEIGHT
24. ADDITIONAL STATEMENT

Under penalty of law, I certify that the products covered by this application for export meet the inspection requirements for the country of destination. I will provide
documentation to FSIS program employees upon request.
26 PRINTED NAME
27. DATE
25. APPLICANT SIGNATURE
I certify that the product was examined in accordance with Agency policy.

28. CERTIFYING OFFICIAL'S SIGNATURE AND TITLE

FSIS FORM 9060-6 (12/13/2016)

29. PRINTED NAME AND TITLE

30. DATE

Instructions for Completing the Application for Export Certificate
1.

Original: Select if the application is original and not a replacement.

2.

Replacement Application/Reason for Replacement: Select if the application is for a replacement certificate. For a
one-to-one replacement certificate, select the reason for the replacement. If the replacement is for a split or consolidated
certificate, select the appropriate box (split or consolidated) and the reason for the replacement.

3.

Certificate Number: Enter the certificate number from the FSIS 9060-5 Meat/Poultry Export Certificate of Wholesomeness,
FSIS 9060-5EP, Egg Products Export Certificate of Wholesomeness or FSIS Form 9060-5S, Siluriformes Fish and Fish Products
Export Certificate of Wholesomeness.

4.

Shipment Type: Select the type of shipment to be certified.

5.

Date of Request: Include the Month, Day, Year (Example 07/11/2017)

6.

Country of Destination: Enter the common country name.

7.

Country of Final Destination: Enter the country of final destination, if that country is different from the Country of Destination in
block 6 and a letterhead/additional certificate is required by the Export Library.

8.

Consignor/Exporter: Enter the name and address (street, city, state, and zip code divided by commas and on separate lines
in the field) of the person or entity applying for the export certificate.

9.

Consignee/Importer: Enter the name and address (street, city, state/province, zip code, (as appropriate) divided by commas
and on separate lines in the field) of the person or entity to whom the consignment is shipped in the country of destination.

10. Export Est. No.: Enter the number of the establishment exporting the product.
11. Export Mark to Be Used: Select either the USDA Export Mark, or Unique Identifier. If Unique Identifier is selected, enter it in
the adjacent field.
12. Description of Product, Including Product Code: Enter the name of the product (i.e. commercial description) as it is to appear
on the export certificate, and the unique product code associated with the product.
13. HACCP Category: Enter the HACCP category abbreviation for each lot of product on the application.

HACCP CATEGORIES
Raw Product - Ground (03B)

Heat Treated - Shelf Stable (03F)

Raw Product - Not Ground (03C)

Fully Cooked - Not Shelf Stable (03G)

Thermally Processed - Commercially
Sterile (03D)

Heat Treated but Not Fully Cooked Not Shelf Stable (03H)

Not Heat Treated - Shelf Stable (03E)

Product with Secondary Inhibitors Not Shelf Stable (03I)

14. Species: Enter the species of the product. If the product contains multiple species, enter the primary species of the product.
15. Maturity less than 30 mos.: This is required for all beef products. Enter “Y” if the products come from animals whose age at time
of slaughter was less than 30 months. Enter “N” if the products come from animals whose age at time of slaughter was 30 months
or older.
16. Frozen/Shelf-Stable: Enter "Y" if the product is frozen or shelf-stable. Enter "N" if the product is not frozen or shelf-stable.
17. Net Weight of Lot: Enter the net weight of each lot.
18. Number of Packages in Lot: Enter the number packages in the lot.

Instructions for Completing the Application for Export Certificate (continued)
19. Type of Packages in Lot: Enter the type of packages in lot, using the abbreviations below.

Abbreviation

Description

BX

Box

CS
CT
CX
DR
MB
PK
PO
BG
BI
BJ
CA
COM
CS
JR
PAL
PL
PU
SW
TB
TN
TU
TY
VA
VP

Case
Carton
Can. Cylinder
Drum
Bag. Multi-ply
Package
Pouch
Bag
Bin
Bucket
Can. Rectangular
Combo Bins
Case
Jar
Pallet
Pail
Tray or Tray Pack
Shrink Wrapped
Tub
Tin
Tube
Tank, Cylindrical
Vat
Vacuum-packed

20. Shipping/identification marks: Enter the unique number that links the product in the lot to the FSIS export certificate.
21. Est. No. on Product: Enter the establishment number marked on the shipping cartons of the product intended for export.
22. Total Net Weight: Enter the total net weight from all lots in the consignment to be certified.
23. Total Number of Packages: Enter the total number of packages from all lots in the consignment to be certified
24. Additional Statement: Enter additional statement(s) if required by the export library to appear in the remarks section of the
export certificate of wholesomeness. This also includes replacement certificate statements for all original certificates generated
in paper-based system outside of PHIS.
25. Applicant Signature: Signature of person listed in block 26.
26. Printed Name: Printed name of person in block 25.
27. Date: Include the Month, Day, Year (Example 10/07/2018).
28. Certifying Official's Signature and Title: Signature and title of certifying official. (i.e. FSIS inspector and/or public health
veterinarian , depending on country requirements).
29. Printed Name and Title: Printed name and title of certifying official in block 28.
30. Date: Include the Month, Day, Year (Example 10/07/2018).