狂犬病予防法及び家畜伝染病予防法(犬に限る)に基づく
動物の輸出検査申請書 |
申請者住所氏名 氏名: PiggyBabes 印 | |
○○○○年 ××月 △△日
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住所: 愛知県名古屋市○×区△◇町 |
動物検疫所名古屋史書名古屋空港出張所長 殿
下記の動物の輸出検査を申請いたします。 |
連絡先: 052-○○○-△△△△ |
動物の種類: CAT | ||
頭数: 1 | ||
名称: POOH | ||
品種: MIX | 毛色: BLACK/WHITE | |
性別: Male | 用途: PET | |
年齢(生年月日): 8 years old ( 01/01/1995 ) | 仕向国: UNITED KINGDOM | |
体長: ○○ cm 体高: △△ cm 体重: ×× kg | ||
搭載船舶(航空機)名: JL54/JL401 | ||
搭載年月日及び搭載地: 05/27/2003 NAGOYA APT | ||
荷送人住所氏名: PiggyBabesママ / 住所 | ||
荷受人住所氏名: PiggyBabes / イギリスの住所 | ||
飼養場所(購入場所): 未記入 | ||
購入年月日: 未記入 | ||
狂犬病予防注射 | 予防液の種類: 未記入 | 接種年月日:未記入 |
接種場所: 未記入 | 接種獣医師氏名:未記入 | |
その他の予防注射 | 予防液の種類:未記入 | 接種年月日:未記入 |
接種場所:未記入 | 接種獣医師氏名:未記入 | |
備考: *到着地: ロンドン・ヒースロー空港 *輸送形態: 携帯品/貨物 |
ANNEX 2
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CERTIFICATION
OF TREATMENT AGAINST TICKS AND TAPEWORMS
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Exporting country: JAPAN |
I Identification of animal |
Microchip number: 392J ○○○ ○○○○ ○○○○○ | Location of microchip: between scaplae | |
Microchip scanner
type: LIFE CHIP READER
Destron-Fearing Corporation |
Age as stated by owner: 8 years old | |
Species: Domestic Cat | Breed: mongrel | Sex: Male |
Coat color: black & partly white | Markings: tuxedo |
II Veterinary
declaration
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I, the undersigned
certify that the animal identified at Section I above has been treated
against ticks and the tapeworm Echinococcus multilocularis, using a
medicinal preparation with a marketing authorization in Japan and that
the preparation used for the treatment of tapeworm contained praziquantel
and for ticks one containing fipronil.
|
Date(D/M/Y)
and time of treatment
(use 24-hour clock) |
Product name
and maker
|
|
Tick treatment |
26/05/2003,
11:00
|
FRONTLINE
SPOT ON CAT
MERIAL |
Tapeworm treatment |
26/05/2003,
11:00
|
Droncit
®
Bayer |
Signature of veterinarian: 獣医さんの署名 | Date(D/M/Y): 26/05/2003 |
Name of veterinarian in BLOCK LETTERS: 獣医さんの氏名(ローマ字) |
Address | Practice stamp |
獣医さんの住所(ローマ字)
|
獣医さんのスタンプ
|
III Official seal |
This certificate and the accompanying re-entry certificate ( rabies certificate) have both been checked and the IATA crate has been sealed by the authorized official ( confirmed by the seal number, signature and stamp opposite): |
Official seal number: AOS ○○○○○ | Official
stamp: 動物検疫所のスタンプ |
Signature: 動物検疫所担当者の署名 | |
Animal Quarantine
Officer, Animal Quarantine Service, MAFF, Japan
|
|
動物検疫所担当者の氏名(ローマ字)
|