Document ref. : NVWA_CLH_VE_B_US_siervogels_EN_0.1_certificaatmodel

Koninkrijk der Nederlanden

GEZONDHEIDSCERTIFICAAT

(veterinair certificaat) certificaatnummer: 

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Koninkrijk der Nederlanden Kingdom of the Netherlands Königreich der Niederlande Royaume des Pays-Bas Reino de los Países Bajos

Ministerie van Landbouw, 

Natuur en Voedselkwaliteit

Ministry of Agriculture, Nature 

and Food Quality

Ministerium für Landwirtschaft, Natur und 

Lebensmittelqualität

Ministère de l’ Agriculture, de 

la Nature et de la Qualité des 

Aliments

Ministerio de Agricultura 

Naturaleza y Calidad 

Alimentaria

Nederlandse Voedsel- en 

Warenautoriteit

Netherlands Food and 

Consumer Product Safety 

Authority

Niederländische Behörde für 

Lebensmittel- und 

Produktsicherheit

Autorité néerlandaise de 

sécurité sanitaire de 

l'alimentation et des produits 

de consommation

Autoridad holandesa de la 

seguridad Alimentaria y de los 

Productos de consumo

Gezondheidscertificaat Health Certificate Gesundheitsbescheinigung Certificat Sanitaire Certificado Sanitario

VETERINARY CERTIFICATE FOR THE EXPORT OF COMMERCIAL BIRDS FROM THE NETHERLANDS

TO THE UNITED STATES OF AMERICA

I. IDENTIFICATION OF THE BIRDS

Product no. Species Identification marks foot ring/microchip no.

Number of animals :

Total number of shipping containers :

II. ORIGIN OF THE BIRDS 

Product no. Name and address of premises of origin

Name and address of exporter :

III. DESTINATION OF THE BIRDS 

Means of conveyance :

Name and address of the consignee :

IV. HEALTH ATTESTATION

The issuing /official veterinarian certifies that all birds covered by this certificate have been inspected and 

attests to the following statements:

1. The veterinarian issuing the certificate completed inspection of the birds covered under this health 

certificate;

2. The bird(s) was/were not vaccinated against any H5 or H7 subtype of avian influenza;

3. The veterinarian issuing the certificate examined the bird(s) within 30 days prior to export, and saw 

no evidence of communicable diseases of birds;

4. The bird(s) covered by this certificate originate from an isolation facility located in the center of a zone 

with a radius of 10 km where no outbreak of notifiable avian influenza and notifiable Newcastle 

disease has occurred for the last 3 months;

5. The bird(s) was/were not vaccinated against Newcastle disease;

Or(*) The bird(s) were vaccinated against Newcastle disease (avian paramyxovirus) at least 21 days 

prior to export, using vaccines that do not contain any velogenic strains of Newcastle disease 

virus;

Vaccine name :

Date :

6. The shipment will not transit through any region where APHIS considers highly pathogenic avian 

influenza to exist;

7. Birds must be inspected within 24 hours of export;

8. The birds were placed in new or appropriately sanitized packaging materials at the premises from 

which the birds were to be exported.

Note. (*) Delete as appropriate.
certificaatnummer: 

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Document ref. : NVWA_CLH_VE_B_US_siervogels_EN_0.1_certificaatmodel

Gedaan te / Done at / Ausgefertigt in / Fait à / Hecho en 

Op / On / Am / Le / El 

Handtekening officiële dierenarts / Signature of the official veterinarian / 

Unterschrift des amtlichen Tierarztes / Signature du vétérinaire officiel / 

Firma veterinario oficial

Naam in hoofdletters / Name in capital letters / Name in Grossbuchstaben / 

Nom en lettres capitales / Nombre en letras capitales