Form VS-16-4 Export Certificate for Animal Products

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 0579-0256. 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.
Port:

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

EXPORT CERTIFICATE FOR
ANIMAL PRODUCTS

Date:

OMB Approved
0579-0256

FOR OFFICIAL USE ONLY

Certificate Number:

This certificate is for veterinary purposes only. It is valid for 30 days after the date of signature (in the case of transport by ship or rail, the time is prolonged by the time of the
voyage).
ADDITIONAL DECLARATIONS

SIGNATURE OF ENDORSING OFFICIAL:

NAME OF ENDORSING OFFICIAL:
TITLE OF ENDORSING OFFICIAL:

NAME AND ADDRESS OF EXPORTER:

DESCRIPTION OF THE CONSIGNMENT
NAME AND ADDRESS OF CONSIGNEE:

PRODUCT (type of product, quantity, unit of measure, and animal product species of origin):

IDENTIFICATION:

VS Form 16-4
JUL 2022

CONVEYANCE: