FSIS 9060-6 APPLICATION FOR EXPORT CERTIFICATE

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U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE

APPLICATION FOR EXPORT CERTIFICATE
3. Certificate Number:

Application Type:
1.

Original:

2.

Replacement Application/Reason for Replacement

4. Shipment Type:

Lost Certificate

Importing Country Border Closure

Commercial Sale

Airline

Incorrect Certificate

Split Shipment

U.S. Military

Importer/Exporter Changed

Consolidated Shipment

Personal
Consumption
Ship's Store

U.S. Embassy

Certificate Missing Required Information
5. Date of Request: (mm/dd/yyyy)

Samples

7. Country of Final Destination:

6. Country of Destination:

8. Consignor/Exporter: (Applicant's name and address)

9. Consignee/Importer: (Name and address)

10. Export Establishment Number:

11. Export Mark to be Used:
USDA Export Mark
Unique Identifier

12.
Description of Product
(Name of Product)

13.
HACCP
Cat.

14.
Species

15.
16.
Maturity Frozen/
Less Than Shelf30 Months Stable

17.
Net Weight
of Lot

21.
20.
19.
18.
Est. Number
Shipping/
Number of Type of
on
Packages Packages Identification
Product
Marks
in Lot
in Lot

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.
25. Applicant Signature:

26. Printed Name:

27. Date Signed: (mm/dd/yyyy)

I CERTIFY that the product was examined in accordance with Agency policy.

28. Certifying Official's Signature and Title:
FSIS 9060-6 (8/15/2025)

29. Printed Name and Title:

30. Date Signed: (mm/dd/yyyy)
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I - CONTINUATION SHEET FOR APPLICATION FOR EXPORT CERTIFICATE
12.
Description of Product
(Name of Product)

FSIS 9060-6 (8/15/2025)

14.
13.
HACCP Species
Cat.

16.
15.
Maturity Frozen/
Less Than Shelf30 Months Stable

17.
Net Weight
of Lot

18.
19.
Number of Type of
Packages Packages
in Lot
in Lot

20.
21.
Shipping/
Est. Number
Identification
on
Marks
Product

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II - CONTINUATION SHEET FOR APPLICATION FOR EXPORT CERTIFICATE

Additional Statement:

FSIS 9060-6 (8/15/2025)

Page 3 of 3