VS Form 17-6: Certificate for Poultry or Hatching Eggs for Export 



Note: This form must be typed. 



DATE OF SHIPMENT 



Self-explanatory. 



NAME AND ADDRESS OF EXPORTER 



Use the complete name and mailing address of the 

 exporter. The Federal Information Processing Standards 

 (FIPS) State codes may be found on the reverse side of 

 the bottom sheet of the carbon-pack form. 



NAME AND ADDRESS OF IMPORTER 



Use the complete name and mailing address of the 

 importer. Contact your Veterinary Services area office 

 for information regarding the FIPS country codes. 



QUANTITY/UNIT 



List eggs by the dozen or hatched poultry by the 

 individual bird. 



VARIETY, STRAIN OR TRADE NAME 



This information may be obtained from the exporter. 



PRODUCT 



Use a checkmark or"X" in ihc bU)i.k that describes ihc 

 item or animal. 



SEX 



Use a checkmark or "X" in the block that describes 

 the animals in each of the Variety/Strain/Trade name 

 groups. "Straight run" means that the sex is unknown 

 (the birds ha\e not been sexed). 



TYPE (Intended use) 



Determine whether the group of birds on a particular 

 line are commercial production stock, multiplier breed- 

 ing stock, or primary breeding stock. Then use a check- 

 mark or "X" under the appropriate header to label the 

 group as egg-type, meat-type, or "other." 



NPIP APPROVAL 



Fill in the appropriate luiinber. 



NPIP CLASSIFICATION - U.S. 



L so a checkmark or"X" to describe the entire group of 

 birds on a particular line. 



TOTAL NUMBER OF UNITS CERTIFIED FOR EXPORT 



Add either in do/ens tor ciiizs or indi\ idual numbers for 

 hatched poultr\-. 



CHECK APPROPRIATE CERTIFICATION BELOW 



Check A or B. 



REMARKS OR ADDITIONAL INFORMATION 



Make additional remarks here it necessary. 



TYPED NAME OF ISSUING VETERINARIAN 



Self-explanatory. 



SIGNATURE OF ISSUING VETERINARIAN 



Sign the form only after it is completed. 



STATUS 



Check the block that best describes your status. 1 his 

 certificate is official only if it is signed by an accredited. 

 State, or Fed^^eral \eterinariaii. 



DATE ISSUED 



Self-explanatory 



SIGNATURE OF ENDORSING FEDERAL 

 VETERINARIAN 



Check with ihe leJeial Area Veterinarian-in-Charge to 

 tultill this lequiiemenl. 



DATE ENDORSED 



This block is completed onl\ it the Federal Area 

 Veterinarian-in-Charge signed in the preceding block. 



16-36 



