EXA4 (Rev. 05/11) PROTECT-Personal

Department for Environment, Food and Rural Affairs Scottish Government 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 address shown below either by post, fax or e-mail. E-mailed application forms must still contain a signature in the Exporter/Agent declaration section. If your application is submitted by fax or e-mail an original copy in the post will not be required.

Specialist Service Centre for Exports Animal Health and Veterinary Laboratories Agency Wavell Drive Rosehill Industrial Estate Carlisle CA1 2TB Tel. 01228 403600 (option 7) Fax. 01228 591900 E-mail: EquineExportsCarlisle@ahvla.gsi.gov.uk

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 AHVLA office will be able to help. http://animalhealth.defra.gov.uk/about/contact-us/postcode.asp

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 (GB) 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.

Animals travelling that board a sea vessel or aeroplane may require a Horse or Pony Welfare License. Application details for such licences can be found at http://defraweb/foodfarm/farmanimal/welfare/transport/horse/index.htm Alternatively, please contact the Equine Export Team in Carlisle, contact details above, for further advice.

Personal data may be stored and processed on computer systems. The Department complies with the standard set out by the Data Protection Act.

EXA4 (Rev. 05/11) PROTECT-Personal

Section I – Please complete in BLOCK LETTERS and BLACK INK

Please give the following details for each animal:

1. Office

Use Only No. of EHC

issued

2. Name of animal

3. Country of

birth

4. (a) Passport No. (b) Passport issued by

5. Description

(a) Breed (b) Sex (c) Colour (d) Age

6. Premises where the

animal will be kept and examined immediately prior to export (to be

given in sufficient detail to be traced on an

Ordnance Survey Map including postcode)

7. Date of

arrival on premises named in column 6

8. Address of

premises including sale yards/

paddocks, where the animal has been kept during the last 3 months (continue on a separate sheet

if necessary)

9. Name, full

address and telephone number of

Official Veterinarian

whom you wish to carry out certification

(a)

(a)

(b)

(b) (c)

(d)

(a)

(a)

(b)

(b) (c)

(d)

(a)

(a)

(b)

(b) (c)

(d)

(a)

(a) (b)

(b) (c)

(d)

(a) (a)

(b)

(b) (c) (d)

Please tick box separate sheet has been used to provide additional information

EXA4 (Rev. 05/11) PROTECT-Personal

Section II – Export Details

Please complete as follows: Export to a Member of State European Union – please complete TRACES EXA31 (Equidae)

application form; Export to a Third Country (non Member State of the EU) but transiting one or more Member

State – please complete TRACES EXA31 (Equidae) 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 i.e. place Where animal will be sent (if applicable)

Name

Address

Town Postcode

7. Third country (importer) consignee (if applicable)

Name

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

export (more than 90days)

temporary export

(e.g. show, race, competition)

temporary import returning

to third country of origin (non-member state)

continuous training

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 Event

Date

Name

Place

EXA4 (Rev. 05/11) PROTECT-Personal

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:

the certificate(s) 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. It is the exporter’s responsibility to check the certificate against any relevant import permit or any advice provided by the competent authority in the importing country. If these do not match, the exporter should contact the Specialist Service Centre for Exports, in Carlisle;

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;

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;

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 of exporter/agent Position in

company

Name in BLOCK LETTERS Date

Address Telephone*

Fax*

Postcode Email (*including national dialling code)

The Animal Health and Veterinary Laboratories Agency is an Executive Agency of the Department for Environment, Food and Rural

Affairs working across Great Britain on behalf of Defra, the Scottish Government and Welsh Assembly Government.

FAIR PROCESSING NOTICE Defra, the Scottish Government, the Welsh Assembly Government and the Food Standards Agency are data controllers in common in respect of relevant personal data processed by the Animal Health and Veterinary Laboratories Agency (AHVLA). For the purposes and usage of the data and the data sharing arrangements, please see the full Data Protection Statement on the AHVLA website. A hard copy of this information can be provided if required; please contact your local AHVLA Office/Laboratory. AHVLA will not permit any unwarranted breach of confidentiality or act in contravention of their obligations under the Data Protection Act 1998.