Part I : Details of dispatched consignment
EUROPEAN UNION
ANNEX I
COMMERCIAL DOCUMENT TO ACCOMPANY RESEARCH AND DIAGNOSTIC SAMPLES TO IRELAND
I.1. Consignor (seller)
Name
I.2 Document reference number
I.3 Import Licence Number
Address
I.4. Date of Departure
I.5 Point of entry
I.6. Consignee (user)
Name
I.7. Place of loading (dispatch)
Name
Address
Address
Registration/Approval number
I.8. Place of origin
Name
I.9. Place of destination
Name
Address
Address
Registration/Approval number
Registration/Approval number
I.10. Description of commodity
1.11. Commodity Code (CN Code)
I.12. Number of packages
I.14. Temperature of products
I.13. Type of packaging
I.15. Identification of the commodities
Species
(scientific name)
Category
Ambient
Controlled Temperature
Chilled
Frozen
Net Weight
or Quantity
Approval number of
establishment manufacturing
plant
Batch number
Part II : Certification
II.1. Declaration by the consignor:
I, the undersigned, declare that:
II.1.1 Part I information is accurate and correct.
II.1.2 The consignment complies with the import license conditions for Ireland and with the Certificate of Registration and Conditions for
establishments registered to use animal by-products and/or derived products for diagnostic, educational or research purposes
II.1.3 The material does not contain any pathogenic agent
II.1.4 Precautions have been taken to eliminate potential public and animal health risks during production, handling, processing, packaging and
dispatch.
II.1.5 The consignment is packed and will be transported in compliance with the Regulations.
II.1.6 The outer packaging is labelled “for research and diagnostic purposes” and the consignment is dispatched to be used for no other purpose.
Signature
Done at ...........................................................................................................................on..............................................................................................
(place)
(date)
Notes
.......................................................................................................................................................................................................................................
(signature of the responsible person/consignor)
..........................................................................................................................................................................................................................................
(name, in capital letters)
Part I:
Box reference I.3: mandatory for third country imports
Box reference I.7 complete if different from I.8. Place of origin.
Box reference I.7 & I.8: approval or registration number if available
Box reference I.9: registration number at Section X of table at:
http://www.agriculture.gov.ie/agri-foodindustry/animalbyproducts/euapprovedabpplants/sectionx/
Box reference I.15:
Category: Specify ABP Category 1, 2 or 3 materials in accordance with Regulation (EC) No 1069/2009.
Approval number of establishment: If available
Batch number: Enter batch number.
Part II:
Reference II.1.5: Consignments must be packed with appropriate UN approved packaging and compliant with IATA and ADR Regulations
during transport
The signature must be in a different colour to that of the printing.
Email to [email protected] or [email protected] not less than 24 hours prior to arrival.
AnnexICommercialDocumentR&DSamplesFINAL17102016