Please send your application form to the appropriate Animal

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Please send your application form to the appropriate Animal Powered By Docstoc
					 Department for Environment, Food and Rural Affairs
 Scottish Executive
 Welsh Assembly Government

Application for an Export Health Certificate for the export of equidae to Countries
other than Member States of the European Union
Please ensure this application is fully completed.
Where certification is in place, applications may take up to TEN working days to process. When new or revised
certification has been produced, the processing of your application may take considerably longer.
 Notes for completing this form
 •     Please send your application form to the appropriate Animal Health office in accordance with the list of
       issuing offices at Appendix A.
 •     Official Veterinarians (OV) providing services to the exporter/agent in connection with export health
       certification will require payment for such services.
 •     If you do not know the name of a Department approved OV in your area, your local Animal Health office will
       be able to help.
 •     It is the responsibility of the exporter to obtain any import permits/licences and transit permissions for the
       country of destination and for any countries through which the consignment will travel.
 •     The submission of this application form should not be delayed if identification details of the animals to be
       exported are not known. Please note, however, that it will not be possible for us to process the certification if
       full post town and postcode details of the destination of the animals are not given.
 •     Exporters must ensure that the correct documentation accompanies the animals to their destination.
 •     Exporters are that they must comply with national legislation covering the welfare of animals during transport.
 •     Animals will not be permitted to return to Great Britain without valid health certification from the country of
       origin. GB export health certification is not sufficient for re-importation.
 •     Animals travelling by air must be transported in containers, crates or cages which satisfy the conditions laid
       down by the International Air Transport Association (IATA). If travelling by sea, the conditions of the carrier
       must be complied with.
 •     Health certificates will be sent to your OV for completion. They will not be sent to you unless specific
       arrangements are in place for you to hold certification at the premises of despatch for the certifying Veterinary
       Surgeon. In such instances, the certification must be held securely and delivered unopened to the Veterinary
       Surgeon.
 •     Personal data may be stored and processed on computer systems. The Department complies with the
       standard set out by the Data Protection Act.
 •     If you are exporting rare or endangered species, additional controls may apply.
       Further details can be obtained from:

       Wildlife Licensing and Registration Service (WLRS),
       Animal Health
       1/17, Temple Quay House, Temple Quay
       2 The Square, Bristol BS1 6EB

       Telephone: 0117 372 8774




 EXA4 (Rev. 09/09)
Section I – Please complete in BLOCK LETTERS and BLACK INK
Please give the following details for each animal:

       1.                 2.                         3.                          4.                         5.                      6.                       7.                    8.                        9.
                                                                                                       Description   Premises where the animal will       Date of       Address of premises
  Office Use        Name of animal            Country of birth         (a) Passport No.               (a) Breed          be kept and examined            arrival on     including sale yards /    Name, full address and
     Only                                                                                             (b) Sex        immediately prior to export (to     premises       paddocks, where the         telephone number of
  No. of EHC                                                           (b) Passport issued by         (c) Colour      be given in sufficient detail to   named in      animal has been kept      Official Veterinarian whom
    issued                                                                                            (d) Age          be traced on an Ordnance          column 6     during the last 3 months      you wish to carry out
                                                                                                                         Survey Map including                         (continue on a separate             certification
                                                                                                                                postcode)                                sheet if necessary )
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                                                                                                                                    Please tick box separate sheet has been used to provide additional information




EXA4 (Rev. 09/09)
                                     Please complete as follows:
                                         •    Export to a Member of State European Union – please complete TRACES EXA31 application
                                              form;
Section II – Export Details              •    Export to a Third Country (non Member State of the EU) but transiting one or more Member
                                              State – please complete TRACES EXA31 application form;
                                         •    Export to a Third Country (non Member State of EU) leaving the EU via a port in Great Britain –
                                              answer all questions on this application form.

1. Name and address of exporter (consignor)



Postcode                                    Telephone Number
2. Country of destination                                         2. (a) Certificate (EHC) number

3. Intended departure date                                        4. Intended departure time

5. Port of departure in Great Britain
6. Third country place destination      Name
   i.e. place Where animal will be
   sent (if applicable)                 Address


                                                          Town                                          Postcode
7. Third country (importer)             Name
   consignee (if applicable)
                                        Address


                                                          Town                                          Postcode
8. Transit countries
9. Means of transport                                        (tick appropriate box(es))
         • truck            • rail                 • ship                    •    air
10. Transport identification/registration number of vehicle (if known)
11. Category of export
• permanent                 • temporary export            • temporary import returning             • continuous
    export (more               (e.g. show, race,             to third country of origin              training
    than 90days)               competition)                  (non-member state)
12. if the horses are being exported for a competition or show, please give the following details:
(a) estimated duration of stay (see not on re-importation on first page)
(b) Date, Name and Place of          Date
    Event
                                     Name

                                     Place




EXA4 (Rev. 09/09)
 Section III – Declaration by exporter or agent

 The details given on this form are correct and complete to the best of my knowledge and belief and where required I
 agree to discharge the reasonable costs of the Department for Environment, Food and Rural Affairs in issuing the
 Export Health Certificate and I understand that:
 (i) the certificate will be provided on the basis of information available at the time and may not necessarily comply
     fully with the requirements of the importing country;
(ii) it is my responsibility to check the certificate with the relevant import permit if/as appropriate or with any advice
     given to me by the importing country;
     no liability for any losses incurred can be accepted by the Department if the certificate issued does not meet the
     importing country’s requirements;
(iii) in the event of suspicion or confirmation of disease, after certification, it may be necessary for the Department to
      withdraw or cancel the health certificate without notice. No liability for losses incurred can be accepted by the
      Department should these circumstances arise;
(iv) where certificates for Veterinary Surgeon signature are sent to the premises of despatch or collected from the
     Department offices by any person other than the certifying Veterinary Surgeon, I undertake to ensure that the
     certificate will be held securely and delivered unopened to the Veterinary Surgeon;
(v) the information contained within this application may be disclosed to other competent veterinary authorities or
    used in the compilation of statistics.


                                                                           Tick as appropriate
 I am:             •    the exporter                   •    the agent of the exporter
 Signature                                                                            Position in
 of exporter/agent                                                                    company
 Name in
                                                                                      Date
 BLOCK LETTERS
 Address                                                                              Telephone*

                                                                                      Fax*

               Postcode                                                               Email
                                                                                                      *including national dialling code


 Data Protection Act
 Defra, the Scottish Executive, the Welsh Assembly Government and the Food Standards Agency are data controllers in respect of
 personal data processed by Animal Health. For the purposes and usage of the data and the data sharing arrangements, please see
 full Data Protection Statement on the Animal Health website: http://www.defra.gov.uk/animalhealth/about-
 us/accesstoinformation/fairprocessing.htm. A hard copy of this can be provided if required; please contact your local Animal Health
 office. Animal Health will not permit any unwarranted breach of confidentiality or act in contravention of their obligations under the Data
 Protection Act 1998.




 EXA4 (Rev. 09/09)
Appendix A
Animal Health offices issuing Third Country horse export health certificates


For horses commencing their journey in Norfolk, Suffolk, Cambridgeshire, Bath and North East Somerset,
North Somerset, City of Bristol, Gloucestershire, South Gloucestershire and Wiltshire please submit your
application to the Bury St Edmunds office at:

Animal Health
Government Buildings
100 Southgate Street
Bury St Edmunds
Suffolk
IP33 2BD

Tel. 01284 778150
Fax. 01284 705684



For horses commencing their journey in Berkshire, Buckinghamshire, Hampshire, Oxfordshire, the Isle of
Wight, Kent, Surrey, East Sussex and West Sussex please submit your application to the Reading office at:

Animal Health
Block A
Government Offices
Coley Park
Reading
Berkshire
RG1 6LY

Tel. 01189 596695
Fax. 01189 392500



For all other horses commencing their journey in England, Scotland and Wales please submit your application to
the Central Operations for Export office at Carlisle:

Animal Health
Central Operations for Exports
Hadrian House
Wavell Drive
Rosehill Industrial Estate
Carlisle
CA1 2TB

Tel. 01228 403600
Fax. 01228 591900

E-mail: CentralOps.Carlisle@animalhealth.gsi.gov.uk




EXA4 (Rev. 09/09)