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JP-Model VC form for  milk products from  Listed  countries (Apr.2017 ver.)  Model Veterinary Certificate for raw milk and milk products from cloven -hoofed animals  
to be exported to Japan from 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 product s (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 n umber (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 ( please tick the appropriate box ) 
 ☐Raw milk and/or milk products have been  produced from raw milk collected only in the exporting 
country and/or Listed  countries, and have been  produced, packaged and stored only in the 
exporting country and/or Listed countries . 
OR 
☐Ingredient s derived from raw milk used in the production of milk products have been  originate 
from the exporting country and/or have been  legally imported into the exporting country . 
AND  
A foot-and-mouth disease ( FMD ) virus inactivation treatment of the products has been  carried out 
in any stage of production by any of the following methods : 
 
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JP-Model VC form for  milk products from  Listed  countries (Apr.2017 ver.)  [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  
☐an inactivation  method  equivalent to the above approved by the exporting country  
 
[Intended for cloven -hoofed animals  consumption  (or likely to use for this purpose)]  
☐UHT 
☐(pH less than 7.0 ) HTST  
☐(pH 7.0  or greater) HTST applied twice  
 
D. Certification  
I, the undersigned official veterinarian, certify that:  
1. The exporting country has been free from FMD, and vaccination against FMD is prohibited in the 
exporting country.  
2. Importation of cloven -hoofed animals that have been vaccinated against FMD is prohibited in the 
exporting country.  
3. The exporting country has an appropriate quarantine system for the import and export of raw milk 
and milk products from the perspective of animal health.  
4. Raw milk and/or milk products to be exported to Japan has 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.   
5. Raw milk and/o r milk products to be exported to Japan has been  produced, packaged and stored 
from raw milk collection to shipment of final products to Japan without contamination by pathogens 
of animal infectious diseases or commingling with raw milk and/or milk product s which do not meet 
Articles 5, 6 -1 and 6 -2 in Animal Health Requirements for  raw milk and/or  milk products to be 
exported to Japan from Listed countries . 
6. Packages and containers such as carton boxes for raw milk and/or 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  
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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