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COUNTRY: UNITED KINGDOM Official certificate to the EU

I.1. Consignor/Exporter I.2. Certificate reference No I.2.a

Name

I.3. Central Competent AuthorityAddress

I.4. Local Competent AuthorityTel. No

I.5. Consignee/Importer I.6. Operator responsible for the consignment

Name Name Address Address

Postal code Postal code Tel. No

I.7. Country of origin ISO I.8. Region of origin Code ISO I.10.I.9. Country ofdestination

I.11 Place of dispatch I.12. Place of destinationName Approval No Name

Address Address

I.13. Place of loading I.14. Date and time of departure

I.15. Means of transport I.16. Entry BCPAeroplane D Vessel D Other D

I.17. Accompanying documentsRoad vehicle D Railway D

Type

No Identification:

I.18. Transport conditions

Ambient D Chilled D Frozen D

I.19. Container No/Seal No

1 5

DEPARTMENT FOR ENVIRONMENT, FOOD AND RURAL AFFAIRS

UNITED KINGDOM GB

en

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COUNTRY: UNITED KINGDOM Official certificate to the EU

I.20. Goods certified asD Human consumption

I.23. Total number of packages I.24. Quantity

Total number Total net weight (Kg) Total gross weight (Kg)

I.25. Description of goods

No Code and CN title

Species (Scientific name) Cold store

Type of packaging

Nature of commodity

2 5

Cutting / Manufacturing plant

Number of packages

Final consumer

D

Net weight

Batch No

Treatment type

1.22. For internal market D 1.21 . For transit D

Third country ISO

en

Definitive import D

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Live bivalve molluscs, echinoderms, tunicates and marine gastropods

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Live bivalve molluscs, echinoderms, tunicates and marine gastropods

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Live bivalve molluscs, echinoderms, tunicates and marine gastropods

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