APHIS Form 2017 Official Export Certificate for Animal Biological Produc

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 0579-0013. The time required to complete this information collection
is estimated to average 1 hour 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.

OMB Approved
0579-0013
EXP: XX/XXXX

This certificate is required by foreign countries to furnish official certification by Veterinary Services that certain products have been prepared in accordance with the Virus-Serum-Toxin Act (9 CFR 112).

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION
SERVICE VETERINARY SERVICES
IMPORTANT: Complete items 1 through 11. Submit the original to:

OFFICIAL EXPORT CERTIFICATE FOR ANIMAL
BIOLOGICAL PRODUCTS
1. DESTINATION (Name and Address of Consignee)

USDA, APHIS, VS
Center for Veterinary Biologics
Inspection and Compliance
1920 Dayton Avenue
Ames, IA 50010
2. NAME AND ADDRESS OF CONSIGNOR (Include ZIP Code)

TO BE COMPLETED BY
VETERINARY SERVICES
CERTIFICATE NO.

DATE ISSUED

ISSUED AT

3.

4.

5.

USDA PRODUCT
CODE NO.
(Numerical order)

10. NO. SHIPPING BOXES

NAME OF PRODUCT

SERIAL
NO.

6.

FINAL CONTAINERS
7.
SIZE
NO.
(doses, ml
or units

8.
EXPIRATION
DATE

9.
LICENSE
NO.

11. SHIPPING MARKS

This certifies that the biological products described above, intended for use in the treatment of animals, have been produced under United States Veterinary Biologics
Establishment License, issued by Veterinary Services as provided by the Virus-Serum-Toxin Act (37 Stat. 832-833, 21 U.S.C. 151-158) and regulations prescribed thereunder,
and are at this date suitable for use in this country.
12. SIGNATURE OF CERTIFYING OFFICIAL

APHIS FORM 2017
APR 2015

13. TITLE

14. DATE