ÐÎÑÑÈÉÑÊÀß ÔÅÄÅÐÀÖÈß                            Ïðèëîæåíèå 5     
                                                                                                   russian federation                                     Ôîðìà n5à

Ìíèñòåðñòâî ñåëüñêîãî õîçÿéñòâà
ministry of agriculture

Äåïàðòàìåíò âåòåðèíàðèè
veterinary department

                                             ÂÅÒÅÐÈÍÀÐÍÛÉ ÑÅÐÒÈÔÈÊÀÒ ¹ _________________
veterinary certificate

íà ýêñïîðòèðóåìûõ èç Ðîññèéñêîé Ôåäåðàöèè
óáîéíûõ, ïëåìåííûõ è äðóãèõ æèâîòíûõ,
ïòèöó, ï÷åë è ðàñïëîäà ï÷åë
for slaughter, breeding, and other animals,
poultry, bees and brood-combs,
exported from the russian federation

Ïîãðàíè÷íûé êîíòðîëüíûé âåòåðèíàðíûé ïóíêò
frontier control veterinary post __________________________________________________________________

Êîëè÷åñòâî æèâîòíûõ
number of animals ____________________________________________________________________________

_______________________________________________________________________________
no           Âèä æèâîòíîãî*           ïîë            ïîðîäà            âîçðàñò             óøíàÿ ìåòêà, êëåéìî, êëè÷êà, âåñ
                   species, kind*               sex              breed                  age                      ear mark, brand, name, weight
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1
___________________________________________________________________________________________
2                       
___________________________________________________________________________________________
3
___________________________________________________________________________________________
4
___________________________________________________________________________________________
5
___________________________________________________________________________________________

          Ïðè ïåðåâîçêå áîëåå 5 æèâîòíûõ ñîñòàâëÿåòñÿ îïèñü æèâîòíûõ, êîòîðàÿ ïîäïèñûâàåòñÿ âåòåðèíàðíûì âðà÷îì ïîãðàíâåòïóíêòà è ÿâëÿåòñÿ íåîòúåìëåìîé ÷àñòüþ äàííîãî ñåðòèôèêàòà.
          the inventory is made, if more than 5 animals are shipped, it is signed by the veterinarian from frontier control veterinary post and constitute an integral part of this certificate.
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* óëåé ñ ï÷åëàìè (ï÷åëèíàÿ ñåìüÿ), ï÷åëîïàêåòû (ñîòîâûå, áåññîòîâûå), ï÷åëèíûå ìàòêè è ïð.
a hive with bees (bee family), bee parcels (honeycombs, unhoneycombs), bee queens etc.

1. Ïðîèñõîæäåíèå æèâîòíûõ / origin of the animals

Íàçâàíèå è àäðåñ ýêñïîðòåðà
name and address of exporter _____________________________________________________________________ ____________________________________________________________________________________________

Ìåñòî ïðîèñõîæäåíèÿ æèâîòíûõ (ìåñòî ðîæäåíèÿ èëè ïðèîáðåòåíèÿ æèâîòíûõ - ñòðàíà, îáëàñòü, ðàéîí)
place of origin of the animals (place of birth or acquirement of the animals - country, region, district)

Æèâîòíûå íàõîäèëèñü â Ðîññèéñêîé Ôåäåðàöèè
animals have been in the russian federation _________________________________________________________
(ñ ðîæäåíèÿ èëè íå ìåíåå 6 ìåñ. / from birth or not less than 6 months)
(Äëÿ äèêèõ æèâîòíûõ óêàçàòü ìåñòî îòëîâà / for wild animals indicate the place of capture)

Ìåñòî êàðàíòèíèðîâàíèÿ
place of quarantine _____________________________________________________________________________

2. Íàïðàâëåíèå æèâîòíûõ / information about destination

Ñòðàíà íàçíà÷åíèÿ
country of destination __________________________________________________________________________

Ñòðàíà òðàíçèòà
country of transit ______________________________________________________________________________

Ïóíêò ïåðåñå÷åíèÿ ãðàíèöû
point of crossing the board _______________________________________________________________________

Íàçâàíèå è àäðåñ ïîëó÷àòåëÿ
name and address of consignee _____________________________________________________________________________________________

Òðàíñïîðò
means of transport _______________________________________________________________________________
(óêàçàòü ¹ âàãîíà, àâòîìàøèíû, ðåéñ ñàìîëåòà, ñóäíà / specify the number of the waggon, truck, flight-number, name of the ship)

3.      ß, íèæåïîäïèñàâøèéñÿ Ãîñóäàðñòâåííûé âåòåðèíàðíûé âðà÷ Ðîññèéñêîé Ôåäåðàöèè, óäîñòîâåðÿþ, ÷òî âûøåóêàçàííûå æèâîòíûå ïðîøëè ______ - äíåâíûé êàðàíòèí ñ åæåäíåâíûì êëèíè÷åñêèì îñìîòðîì, íå èìåëè êîíòàêòà ñ äðóãèìè æèâîòíûìè, îáñëåäîâàíû â äåíü âûäà÷è ñåðòèôèêàòà è íå èìåþò êëèíè÷åñêèõ ïðèçíàêîâ èíôåêöèîííûõ çàáîëåâàíèé.
          i, the undersigned veterinarian of the government of the russian federation certify, that abovementioned animals were placed in
______ days quarantine with daily clinical examinations, have no contacts with the other animals, were examined at the day of issue of the certificate and showed no clinical symptoms of the infectious diseases.

          Òðàíñïîðòíûå ñðåäñòâà î÷èùåíû è ïðîäåçèíôèöèðîâàíû ïðèíÿòûìè â Ðîññèéñêîé Ôåäåðàöèè ìåòîäàìè è ñðåäñòâàìè.           means of transport have been cleaned and disinfected by the methods and means, approved in the russian federation.

          Æèâîòíûå âûõîäÿò èç ìåñòíîñòè, ãäå íå ðåãèñòðèðîâàëèñü:
          the animals came from the locality free from: _________________________________________________________________________ â òå÷åíèå ïîñëåäíèõ ________ 
                                                                                                                                                                                  during the last _________________________________________________________________________ â òå÷åíèå ïîñëåäíèõ ________
                                                                                                                                                                                  during the last _________________________________________________________________________ â òå÷åíèå ïîñëåäíèõ ________
                                                                                                                                                                                  during the last _________________________________________________________________________ â òå÷åíèå ïîñëåäíèõ ________
                                                                                                                                                                                  during the last _________________________________________________________________________ â òå÷åíèå ïîñëåäíèõ ________
                                                                                                                                                                                  during the last

          Æèâîòíûå âûõîäÿò èç õîçÿéñòâ, ãäå íå ðåãèñòðèðîâàëèñü:
          the animals came from the premises free from: _________________________________________________________________________ â òå÷åíèå ïîñëåäíèõ ________
                                                                                                                                                                                  during the last _________________________________________________________________________ â òå÷åíèå ïîñëåäíèõ ________
                                                                                                                                                                                  during the last _________________________________________________________________________ â òå÷åíèå ïîñëåäíèõ ________
                                                                                                                                                                                  during the last _________________________________________________________________________ â òå÷åíèå ïîñëåäíèõ ________
                                                                                                                                                                                  during the last _________________________________________________________________________ â òå÷åíèå ïîñëåäíèõ ________
                                                                                                                                                                                  during the last

          Æèâîòíûå â ïåðèîä ______ - äíåâíîãî êàðàíòèíà èññëåäîâàëèñü â ãîñóäàðñòâåííîé âåòåðèíàðíîé ëàáîðàòîðèè, èìåþùåé ðàçðåøåíèå íà òàêèå èññëåäîâàíèÿ, ñ îòðèöàòåëüíûì ðåçóëüòàòîì íà:
          animals during ______ days quarantine were examined in the state veterinary laboratory, licensed for conducting such examination, with negative results for:
____________________________________________________________________________ «____» __________ 19 ___ ã. ____________________________________________________________________________ «____» __________ 19 ___ ã. ____________________________________________________________________________ «____» __________ 19 ___ ã. ____________________________________________________________________________ «____» __________ 19 ___ ã. ____________________________________________________________________________ «____» __________ 19 ___ ã. ____________________________________________________________________________ «____» __________ 19 ___ ã. ____________________________________________________________________________ «____» __________ 19 ___ ã.

          Ïðîâåäåíà âàêöèíàöèÿ ïðîòèâ:
          animals were vaccinated against:
____________________________________________________________________________ «____» __________ 19 ___ ã. ____________________________________________________________________________ «____» __________ 19 ___ ã. ____________________________________________________________________________ «____» __________ 19 ___ ã. ____________________________________________________________________________ «____» __________ 19 ___ ã. ____________________________________________________________________________ «____» __________ 19 ___ ã.

          Æèâîòíûå îáðàáîòàíû ïðîòèâ ïàðàçèòîâ:
          animals were treated parasites:
____________________________________________________________________________ «____» __________ 19 ___ ã. ____________________________________________________________________________ «____» __________ 19 ___ ã.

          Óïàêîâî÷íûé ìàòåðèàë è ñîïðîâîæäàþùèå ïðîäóêòû ïðîèñõîäÿò íåïîñðåäñòâåííî èç õîçÿéñòâà ýêñïîðòåðà è íå èìåëè êîíòàêòà ñ áîëüíûìè æèâîòíûìè èëè êîíòàìèíèðîâàííûìè ïðîäóêòàìè è ìàòåðèàëàìè.
          the packing material and accompanying products derived directly from the premise of the exporter and have not been in contacts with diseased animals or contaminated products and substances.

                                                                                                                                  Ñîñòàâëåíî / made on «____» _____________ 19 ____ ã. Âåòåðèíàðíûé âðà÷ / veterinarian ______________________________________________________________________
(äîëæíîñòü, ôàìèëèÿ / title, name)

Ïîäïèñü / signature : __________________________________________________________________________________

Ïå÷àòü / stamp

          Ñåðòèôèêàò äåéñòâèòåëåí ïðè âîçâðàùåíèè â Ðîññèéñêóþ Ôåäåðàöèþ èç çàðóáåæíûõ ñòðàí ñïîðòèâíûõ, öèðêîâûõ è äðóãèõ æèâîòíûõ â òå÷åíèå 90 äíåé ñ ìîìåíòà âûäà÷è áåç ïðîâåäåíèÿ äîïîëíèòåëüíûõ èññëåäîâàíèé è îáðàáîòîê ïðè óñëîâèè, ÷òî æèâîòíûå íå íàõîäèëèñü â ìåñòàõ, ãäå èìåëèñü âñïûøêè èíôåêöèîííûõ çàáîëåâàíèé, ÷òî äîëæíî áûòü ïîäòâåðæäåíî ãîñóäàðñòâåííîé âåòåðèíàðíîé ñëóæáîé ýòèõ ñòðàí.
          the certificate is valid for returning into the russian federation from the foreign countries of sport, circus and other animals within 90 days after issuing without additional testing and treatment, if the animals have not been in the localities, where infectious diseases were registered, what must be confirmed by the state veterinary service of these countries.

           Ñåðòèôèêàò ñ÷èòàåòñÿ íåäåéñòâèòåëüíûì, åñëè æèâîòíûå â òå÷åíèå 24 ÷àñîâ ïîñëå åãî ïîäïèñàíèÿ íå áûëè ïîãðóæåíû íà òðàíñïîðòíîå ñðåäñòâî.
          the certificate is not valid, if the animals were not loaded on the vehicle during 24 hours after the signing.