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JP-Model VC form for milk products from countries other than Listed countries  (Apr.2017 ver.)  Model Veterinary Certificate for milk products from cloven -hoofed animals  
to be exported to Japan from  countries other than  Listed  countries  
 
Certificate No. ：                         
 
A. Details of dispatched consignment  
 A-1. Exporting country ：                                                     
 A-2. Container No. ：                                                        
 A-3. Seal No. ：                                                           
 A-4. Shipping mark ：                                                                  
A-5. Type of packages ：                                                                   
A-6. Name and address of consignor ：                                                
                                                                                      
A-7. Name and address of consignee ：                                               
                                                                                      
 
B. Identification of products （Model Annex form can be used if needed ） 
 B-1. Type of products (e.g. Cheese, Butter) ：                                                 
 B-2. Net weight ：                                                           
 B-3. Number of packages ：                                                           
 B-4. Date of production ：                                                           
 B-5. Animal species of dairy ingredients ：                                                    
 B-6. Country of origin ：                                                   
 B-7. Establishment number (or name and address) ：                                     
 B-8. Purpose of use ( please tick the appropriate box )： 
☐Human consumption  
☐Animal consumption ( ☐cloven -hoofed animals / ☐other animals / ☐pet food)  
☐To be determined ( likely  to use for cloven -hoofed animal consumption )  ☐Other (       ) 
 Remarks ：                                                                
 
C. Kind of processing treatment  
 C-1. A foot-and-mouth disease  (FMD ) virus inactivation treatment of milk products has been carried 
out in any stage of production by any of the following methods  (please tick the appropriate box) : 
 
[NOT intended for cloven -hoofed -animals  consumption ] 
☐a minimum temperature of 132°C for at least one second  in liquid form  (UHT)  
☐(pH less than 7.0 ) a minimum temperature of 72°C for at least 15 seconds  in liquid form  (HTST)  
☐(pH 7.0  or greater) HTST  applied  twice  
☐maintaining a pH less than 6 for at least one hour  
 
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JP-Model VC form for milk products from countries other than Listed countries  (Apr.2017 ver.)  [Intended for cloven -hoofed animals  consumption  (or likely to use for this purpose)]  
☐HTST  applied  twice  
 ☐HTST combined with another physical treatment, maintaining a pH less than 6 for at least on e 
hour or additional heating to at least 72°C combined with desiccation  
☐UHT combined with another physical treatment, maintaining a pH less than 6 for at least one hour 
or additional heating to at least 72°C combined with desiccation  
 
C-2. Name of count ry where C -1 was carried out (if different from A -1)：                         
 
D. Certification  
I, the undersigned official veterinarian, certify that:  
1. Milk products to be exported to Japan have been  produced from raw milk obtained from clinically 
healthy animals, and  it is prohibited to use raw milk obtained from animals infected with animal 
infectious diseases as an ingredient according to legislation of the exporting country.  
2. Raw milk used in th e production of milk products to be exported to Japan  has originate d from 
herds which were not infected or suspected of being infected with FMD at the time of milk 
collection.  
3. Milk products to be exported to Japan have been produced, packaged and store d from raw milk 
collection to shipment of final products to Japan without contamination by pathogens of animal 
infectious diseases or commingling with milk products which do not meet Articles 1 to 3 in Animal 
Health Requirements for milk products to be exported to Japan from countries other than Listed 
countries . 
4. Packages and containers such as carton boxes for milk products to be exported to Japan have 
been  clean and hygienic.  
 
 
 Competent authority ：                               
 
 Signature of official veterinarian ：                          
 
 Printed name and title of official veterinarian ：                  
 
 Date of issue ：                                  
 
Official stamp 1 / 1 
JP-Model Annex form for VC form for milk products (Apr.2017 ver.)  Model  Annex form  
Certificate No. ：                   
Identification of products  
Type of products  
 (e.g. Cheese, Butter)  Net 
weight  Number of  
packages  Date of  
production  Animal species of 
dairy ingredients  Country of origin  Establishment number  
(or name and address)  
                     
                     
                     
                     
                     
Total        Purpose  of 
use 
 ☐Human consumption  
☐Animal consumption ( ☐cloven -hoofed animals / ☐other animals / ☐pet food)  
☐To be determined ( likely  to use for cloven -hoofed animal consumption )  
☐Other (                                                         ) 
  
Remarks ：                               
 
 
 Competent authority ：                          
 
 Signature of official veterinarian ：                      
 
 Printed name and title of official veterinarian ：               
 
 Date of issue ：                              
Official stamp