DA-247 Sanitary Certificate Request - Peru

Export Health Certificate Request Forms

DA-247 Sanitary-Peru 1-30-19

Export Certificates

OMB: 0581-0283

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Form Approved OMB No. 0581-0283


U. S DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

SANITARY CERTIFICATE REQUEST


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.

TYPE Faxed Certificate* 0 Additional Copies* *additional charges apply

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

contact information

mailing information

  1. CONTACT NAME

     

7. COMPANY

  1. AMS BILLING ACCT.

     

8. CONTACT

     

  1. BILLING REFERENCE

     

9. STREET

     

  1. E-MAIL ADDRESS

     

10. CITY

     

  1. CONTACT PHONE

     

11. STATE

     

  1. FAX

     

12. ZIP

     

CONSIGNOR

13. NAME

     

14. ADDRESS

     

15. CITY/STATE

     

CONSIGNEE

16. NAME

     

17. ADDRESS

     

18. COUNTRY CODE

PE

IDENTIFICATION OF DAIRY PRODUCTS

19. DESCRIPTION OF COMMODITY

     

20. PRODUCT IDENTIFICATION

     

21. TYPE OF PACKAGING

     

22. NUMBER OF PACKAGING UNITS

     

23. NET WEIGHT

     

24. PASTEURIZED?

YES

25. INDIVIDUALLY PACKED?

YES

26. SENASA PERMIT NO.

     

MANUFACTURER

27. PLANT NUMBER

     

     

     

SIGNATURE (for faxed or mailed copies)


29. DATE

January 16, 2021


**For fastest processing, please attach this form and a PDF shipping label in an email to [email protected].


DA-247 (01/2013)


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 Created2021-01-16

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