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APPENDIX IV 



Convention on International Trade in Endangered Species of 

 Wild Fauna and Flora 



EXPORT per:hit no. 



Exporting Countin/: Valid Until: 



(Date) 



This permit is issued to: 



address: 



who declares that he is aware of the provisions of the Convention, for 

 the purpose of exporting: 



(specimen (s), or part (s) or derivative (s) of specimen (s) )^ 



of a species listed in 



Appendix I ) 



Appendix II )- 



Appendix III of the Convention as specified below.) 



(bred in captivity or cultivated in _ )- 



This (these) specimen(s) is (are) consigned to: 



address: country: 



at on 



(signature of the applicant for the permit) 



at on 



(stamp and signature of the Management 

 Authority issuing the export permit) 



Description oj the specimen's) or part's) or derivative's) of specimen's), 

 including any mark's) affixed 



Living speciinens Pai ts or dcrivativos 



SD'^cies (scientific Size (or Mark Typu of Mark 



and common name) Number Sex volume) (if any) Quantity goods (if any) 



Note: Stamps of the authorities inspecting: 



(6) On impovtaiioii. (This stamp voids this permit for further trade purposes, and this permit shall 

 be surrendered to the Management Authority.) 



1 Indicate the type of proQuct. 



2 Delete If not applicable. 



