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.