(Applicant's name and address)

11. EXPORT MARK TO BE USED:

18.

NO. OF

PACKAGES

IN LOT

USDA EXPORT MARK

UNIQUE IDENTIFIER

17.

NET

WEIGHT

OF LOT

9. CONSIGNEE/IMPORTER (name and address)

16.

FROZEN/

SHELFSTABLE PACKAGES

14.

SPECIES

15.

MATURITY

LESS

THAN

30 MOS.

13.

HACCP

CAT.

SAMPLE

23. TOTAL NO. OF PACKAGES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    

    

   

   

  

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a

valid OMB control number. The valid OMB control number for this information collection is 0583-0153. The time required to complete this information collection is estimated to average

20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the

collection of information.

U.S. DEPARTMENT OF AGRICULTURE

FOOD SAFETY AND INSPECTION SERVICE

APPLICATION FOR EXPORT CERTIFICATE

APPLICATION TYPE

1. ORIGINAL

2. REPLACEMENT APPLICATION / REASON FOR REPLACEMENT

LOST CERTIFICATE IMPORTING COUNTRY BORDER CLOSURE

INCORRECT CERTIFICATE SPLIT SHIPMENT

IMPORTER/EXPORTER CHANGED CONSOLIDATED SHIPMENT

CERTIFICATE MISSING REQUIRED INFORMATION

3. CERTIFICATE NO.

4. SHIPMENT TYPE

COMMERCIAL SALE AIRLINE

PERSONAL U.S. MILITARY

CONSUMPTION

SAMPLES

SHIP'S STORE U.S. EMBASSY

5. DATE OF REQUEST (mm/dd/yyyy) 6. COUNTRY OF DESTINATION 7. COUNTRY OF FINAL DESTINATION

8. CONSIGNOR/EXPORTER

10. EXPORT EST. NO.

12.

DESCRIPTION OF PRODUCT

(including Product Code)

22. TOTAL NET WEIGHT

This sample is not to be used.

19. 20. 21. TYPE SHIPPING/ EST. NO. OF IDENTIFICATION ON

MARKS PRODUCT IN LOT

24. ADDITIONAL STATEMENT

Under penalty of law, I certify that the products covered by this application for export meet the inspection requirements for the country of destination. I will provide

documentation to FSIS program employees upon request.

25. APPLICANT SIGNATURE 26 PRINTED NAME 27. DATE

I certify that the product was examined in accordance with Agency policy.

28. CERTIFYING OFFICIAL'S SIGNATURE AND TITLE 29. PRINTED NAME AND TITLE 30. DATE

FSIS FORM 9060-6 (05/04/2017)
Enter the name and address (street, city, state, and zip code divided by commas and on separate lines

in the field) of the person or entity applying for the export certificate. If desired, the applicant can also include a phone number and email

Enter the name and address (street, city, state/province, zip code, (as appropriate) divided by commas

and on separate lines in the field) of the person or entity to whom the consignment is shipped in the country of destination.

applicant can also include a phone number and email address.

Enter the number of the establishment exporting the product.

Select either the USDA Export Mark, or Unique Identifier. If Unique Identifier is selected, enter it in

12. Description of Product, including Product Code: Enter the labeled name of the product (i.e. commercial description) as it is to appear on

the export certificate, and the unique product code associated with the product if desired.

Enter the HACCP category code for each lot of product on the application.

Heat Treated but Not Fully Cooked

Not Shelf Stable (03H)

Raw Product - Ground (03B) Heat Treated - Shelf Stable (03F)

Raw Product - Not Ground (03C)

HACCP CATEGORIES

Fully Cooked - Not Shelf Stable (03G)

Thermally Processed

SAMPLE

- Commercially 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Instructions for Completing the Application for Export Certificate

1. Original: Select if the application is original and not a replacement.

2. Replacement Application/Reason for Replacement: Select if the application is for a replacement certificate. For a one-to-one

replacement certificate, select the reason for the replacement. If the replacement is for a split or consolidated certificate, select the

appropriate box (split or consolidated) and the reason for the replacement.

3. Certificate Number: Enter the certificate number from the FSIS 9060-5 Meat/Poultry Export Certificate of Wholesomeness,

FSIS 9060-5EP, Egg Products Export Certificate of Wholesomeness or FSIS Form 9060-5S, Siluriformes Fish and Fish Products

Export Certificate of Wholesomeness.

4. Shipment Type: Select the type of shipment to be certified.

5. Date of Request: Include the Month, Day, Year (Example 07/11/2017)

6. Country of Destination: Enter the common country name.

7. Country of Final Destination: Enter the country of final destination, if that country is different from the Country of Destination in

block 6 and a letterhead/additional certificate is required by the Export Library.

8. Consignor/Exporter:

address.

9. Consignee/Importer:

If desired, the

10. Export Est. No.:

11. Export Mark to Be Used: 

the adjacent field.

13. HACCP Cat.:

-

Sterile (03D) 

This sample is not to be used.

Product with Secondary Inhibitors -

Not Shelf Stable (03I) Not Heat Treated - Shelf Stable (03E)

14. Species: Enter the species of the product. If the product contains multiple species, enter the primary species of the product.

15. Maturity less than 30 mos.: This is required for all beef products. Enter “Y” if the products come from animals whose age at time

of slaughter was less than 30 months. Enter “N” if the products come from animals whose age at time of slaughter was 30 months

or older.

16. Frozen/Shelf-Stable: Enter "Y" if the product is frozen or shelf-stable. Enter "N" if the product is not frozen or shelf-stable.

17. Net Weight of Lot: Enter the net weight of each lot in pounds or kilograms, or pounds and kilograms. For pounds only, enter

the weight with “lbs” following the number. For kilograms only, enter the weight with “kgs” following the number. For pounds and

kilograms, enter the pound weight with “lbs” following the number, then below the pound weight in the same box, enter the

kilogram weight in with “kgs” following the numbers in parentheses, e.g. (22,000.00 kgs).

18. Number of Packages in Lot: Enter the number packages in the lot.
Shipping/Identification Marks: If shipping/identification marks are required by the importing country as indicated in the

Export Library, those listed on the application should match those on the certificate.

Enter the establishment number marked on the shipping cartons of the product intended for export.

Enter the total net weight in pounds or kilograms, or pounds and kilograms from all lots in the consignment

to be certified. For pounds only, enter the weight with “lbs” following the number. For kilograms only, enter the weight with

“kgs” following the number. For pounds and kilograms, enter the pound weight with “lbs” following the number, then next to

the pound weight in the same box, enter the kilogram weight in with “kgs” following the numbers in parentheses, e.g

Bucket

Can. Rectangular

Combo Bins

Jar

Pallet

Pail

Tray or Tray Pack

Shrink Wrapped

Tub

Tin

Tube

Tank, Cylindrical

Vat

Vacuum-packed

SAMPLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Instructions for Completing the Application for Export Certificate (continued)

19. Type of Packages in Lot: Enter the type of packages in lot, using the abbreviations below.

Abbreviation Description

BX Box

CS Case

CT Carton

CX Can. Cylinder

DR Drum

MB Bag. Multi-ply

PK Package

PO Pouch

BG Bag

BI Bin

BJ

CA

COM

JR

PAL

PL

PU

SW

TB

TN

TU

TY

VA

VP

This sample is not to be used.

20.

21. Est. No. on Product: 

22. Total Net Weight: 

(22,000.00 kgs).

23. Total Number of Packages: Enter the total number of packages from all lots in the consignment to be certified.

24. Additional Statement: Enter additional statement(s) if required by the export library to appear in the remarks section of the

export certificate of wholesomeness. This also includes replacement certificate statements for all original certificates generated

in paper-based system outside of PHIS.

25. Applicant Signature: Signature of person listed in block 26.

26. Printed Name: Printed name of person in block 25.

27. Date: Include the Month, Day, Year (Example 10/07/2018).

28. Certifying Official's Signature and Title: Signature and title of certifying official. (i.e. FSIS inspector and/or public health

veterinarian, depending on country requirements).

29. Printed Name and Title: Printed name and title of certifying official in block 28.

30. Date: Include the Month, Day, Year (Example 10/07/2018).