Document ref. : NVWA_CLH_VE_B_US_duiven_EN_0.2_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 PIGEONS AND DOVES (COLUMBIFORMS) SPECIES

FROM THE NETHERLANDS TO THE UNITED STATES OF AMERICA

I. IDENTIFICATION OF THE BIRDS

Product no. Species Identification (microchip, leg 

band or tattoo)

Age Sex

Number of animals :

Seal number :

II. ORIGIN OF THE BIRDS

Product no. Name and address of premises of origin

Name and address of exporter :

III. DESTINATION OF THE BIRDS

Name and address of the consignee :

Means of conveyance :

IV. HEALTH ATTESTATION

The issuing / official veterinarian certifies for export that all columbiforms covered by this certificate have 

been inspected and attests to the following statements, the columbiforms

1. The columbiform(s) was/were shipped in new or appropriately sanitized containers prior to current 

use;

2. The columbiform(s) did not come in contact with wild birds or poultry within 30 days previous to 

exporting on the premise of origin;

3. Have not been vaccinated with a vaccine for any H5 or H7 subtype of avian influenza;

4. Have been examined prior to movement from the premise of origin and there was no evidence of 

poultry communicable disease;

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

Or(*) The columbiform(s) was/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;

Name : See annex

Date : See annex

6. Shipment did not travel under official seal through zones that were restricted for outbreaks of 

Newcastle disease or HPAI in commercial poultry. Were moved without co-mingling the shipment with 

any other avians after leaving the premise of origin;

7. Birds were inspected within 24 hours of export.

Note.

(*) Delete as appropriate.
certificaatnummer: 

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Document ref. : NVWA_CLH_VE_B_US_duiven_EN_0.2_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 
certificaatnummer: 

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Document ref. : NVWA_CLH_VE_B_US_duiven_EN_0.2_certificaatmodel

Annex

VACCINATION INFORMATION (DECLARATION IV.5.)

Identification (microchip, leg band or tattoo) Name Date

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