ANNEX IV

MODEL OFFICIAL CERTIFICATE REFERRED TO IN ARTICLE 11 OF COMMISSION IMPLEMENTING REGULATION (EU) 2019/1793 FOR THE ENTRY INTO THE UNION OF CERTAIN FOOD OR FEED

COUNTRY

Official certificate to the EU

Part 1: Details of dispatched consignment

I.1. Consignor/Exporter

Name

Address

Tel. No

I.2. Certificate reference No

I.2.a IMSOC reference No

I.3. Central Competent Authority

I.4. Local Competent Authority

I.5. Consignee/Importer

Name

Address

Postal code

Tel. No

I.6. Operator responsible for the consignment

Name

Address

Postal code

I.7. Country of origin

ISO

I.8. Region of origin

I.9. Country of destination

ISO

I.10.

I.11. Place of dispatch

Name

Address

I.12. Place of destination

Name

Address

I.13. Place of loading

I.14. Date and time of departure

I.15. Means of transport

Aeroplane

Road vehicle

Identification:

Vessel

Railway

Other

I.16. Entry BCP

I.17. Accompanying documents

Laboratory report

No.

Date of issuance:

Other

Type

No

I.18. Transport conditions

Ambient

Chilled

Frozen

I.19. Container No/Seal No

I.20. Goods certified as

Human consumption

Feedingstuff

I.21.

I.22.

For internal market:

I.23. Total number of packages

I.24. Quantity

Total number

Total net weight (Kg)

Total gross weight (Kg)

I.25. Description of goods

No Code and CN title

Species (Scientific name)

Final consumer Number of packages

Net weight Batch No

Type of packaging

COUNTRY Certificate for the entry into the Union of food or feed

Part II: Certification

II. Health information

II.a Certificate reference No

II.b IMSOC reference No

II.1. I, the undersigned, declare that I am aware of the relevant provisions of Regulation (EC) No 178/2002 of the and of the Council of 28 January 2002 laying down the general principles and requirements of food law, establishing the European Food Safety Authority and laying down procedures in matters of food safety (OJ L 31, 1.2.2002, p. 1), Regulation (EC) No 852/2004 of the European Parliament and of the Council of 29 April 2004 on the hygiene of foodstuffs (OJ L 139, 30.4.2004, p. 1), Regulation (EC) No 183/2005 of the European Parliament and of the Council of 12 January 2005 laying down requirements for feed hygiene (OJ L 35, 8.2.2005, p. 1) and Regulation (EU) 2017/625 of the European Parliament and of the Council of 15 March 2017 on official controls and other official activities performed to ensure the application of food and feed law, rules on animal health and welfare, plant health and plant protection products, amending Regulations (EC) No 999/2001, (EC) No 396/2005, (EC) No 1069/2009, (EC) No 1107/2009, (EU) No 1151/2012, (EU) No 652/2014, (EU) 2016/429 and (EU) 2016/2031 of the European Parliament and of the Council, Council Regulations (EC) No 1/2005 and (EC) No 1099/2009 and Council Directives 98/58/EC, 1999/74/EC, 2007/43/EC, 2008/119/EC and 2008/120/EC and repealing Regulations (EC) No 854/2004 and (EC) No 882/2004 of the European Parliament and of the Council, Council Directives 89/608/EEC, 89/662/EEC, 90/425/EEC, 91/496/EEC, 96/23/EC, 96/93/EC and 97/78/EC and Council Decision 92/438/EEC (Official Controls Regulation) (OJ L 95, 7.4.2017, p. 1), and I certify that:

(1) Either

[II.1.1. ☐ the food of the consignment described above with the identification code … (indicate the identification code for the consignment referred to in Article 9(1) of Implementing Regulation (EU) 2019/1793) was produced in accordance with the requirements of Regulations (EC) No 178/2002 and (EC) No 852/2004 and in particular:

primary production of such food and associated operations listed in Annex I to Regulation (EC) No 852/2004 comply with the general hygiene provisions laid down in part A of Annex I to Regulation (EC) No 852/2004;

(1) (2) and, in the case of any stage of production, processing and distribution after primary production and related operations:

it has been handled and, where appropriate, prepared, packaged and stored in a hygienic manner in accordance with the requirements of Annex II to Regulation (EC) No 852/2004 and,

it comes from (an) establishment(s) implementing a programme based on the hazard analysis and critical control points (HACCP) principles in accordance with Regulation (EC) No 852/2004;]

(1) Or

[II.1.2. ☐ the feed of the consignment described above with the identification code … (indicate the identification code for the consignment referred to in Article 9(1) of Implementing Regulation (EU) 2019/1793) was produced in accordance with the requirements of Regulations (EC) No 178/2002 and (EC) No 183/2005 and in particular:

primary production of such feed and associated operations listed in Article 5(1) of Regulation (EC) No 183/2005 comply with the provisions of Annex I to Regulation (EC) No 183/2005;

(1) (2) and, in the case of any stage of production, processing and distribution after primary production and related operations:

it has been handled and, where appropriate, prepared, packaged and stored in a hygienic manner in accordance with the requirements of Annex II to Regulation (EC) No 183/2005 and,

it comes from (an) establishment(s) implementing a programme based on the hazard analysis and critical control points (HACCP) principles in accordance with Regulation (EC) No 183/2005.]

and

II.2. I, the undersigned, according to the provisions of Implementing Regulation (EU) 2019/1793 on the temporary increase of official controls and emergency measures governing the entry into the Union of certain goods from certain third countries implementing Regulations (EU) 2017/625 and (EC) No 178/2002 of the European Parliament and repealing Commission Regulations (EC) No 669/2009, (EU) No 884/2014, (EU) No 2015/175, (EU) No 2017/186 and (EU) 2018/1660, certify that:

(3) Either

[II.2.1. ☐ Certification for food and feed of non-animal origin listed in Annex II to Implementing Regulation (EU) 2019/1793, as well as for compound food listed in that Annex, due to contamination risk by mycotoxins

from the consignment described above, samples were taken in accordance with:

☐ Commission Regulation (EC) No 401/2006 to determine the level of aflatoxin B1 and level of total aflatoxin contamination for food

☐ Commission Regulation (EC) No 152/2009 to determine the level of aflatoxin B1 for feed

on … (date), subject to laboratory analyses on … (date)

in the … (name of the laboratory) with methods covering at least the hazards identified in Annex II to Commission Implementing Regulation (EU) 2019/1793

The details of the methods of laboratory analyses and all results are attached and show compliance with Union legislation on maximum levels of aflatoxins.]

(3) Or

[II.2.2. ☐ Certification for food and feed of non-animal origin listed in Annex II to Commission Implementing Regulation (EU) 2019/1793, as well as for compound food listed in that Annex, due to contamination risk by pesticide residues

from the consignment described above, samples were taken in accordance with Commission Directive 2002/63/EC on … (date), subject to laboratory analyses on … (date) in the … (name of the laboratory) with methods covering at least the hazards identified in Annex II to Implementing Regulation (EU) 2019/1793

The details of the methods of laboratory analyses and all results are attached and show compliance with Union legislation on maximum residue levels of pesticides.]

(3) Or

[II.2.3. ☐ Certification for guar gum listed in Annex II to Implementing Regulation (EU) 2019/1793, including for compound food listed in that Annex, due to contamination risk by pentachlorophenol and dioxins

from the consignment described above, samples were taken in accordance with Commission Directive 2002/63/EC on … (date), subject to laboratory analyses on … (date) in the … (name of the laboratory) with methods covering at least the hazards identified in Annex II to Implementing Regulation (EU) 2019/1793

The details of the methods of laboratory analyses and all results are attached and show that the goods do not contain more than 0.01 mg/kg pentachlorophenol (PCP).]

(3) Or

[II.2.4. ☐ Certification for food of non-animal origin listed in Annex II to Commission Implementing Regulation (EU) 2019/1793, as well as for compound food listed in that Annex due to risk of microbiological contamination

from the consignment described above, samples were taken in accordance with Annex III to Commission Implementing Regulation (EU) 2019/1793

on … (date), subject to laboratory analyses on … (date)

in the … (name of the laboratory) with methods covering at least the hazards identified in Annex II to Implementing Regulation (EU) 2019/1793

The details of the methods of laboratory analyses and all results are attached and show the absence of Salmonella in 25 g.

II.3. This certificate has been issued before the consignment to which it relates has left the control of the competent authority issuing it.

II. 4. This certificate is valid during four months from the date of issue, but in any case no longer than six months from the date of the results of the last laboratory analyses.

Notes

See notes for completion in this Annex.

Part II:

(1) Delete or cross out as appropriate (e.g. if food or feed)

(2) It applies only in the case of any stage of production, processing and distribution after primary production and related operations.

(3) Delete or cross out as appropriate in the case where you do not select this point for providing the certification.

The colour of the signature shall be different to that of the printing. The same rule applies to stamps other than those that are embossed or are a watermark.

Certifying officer:

Name (in capital letters): Qualification and title:

Date: Signature:

Stamp

NOTES ON THE COMPLETION OF THE MODEL OFFICIAL CERTIFICATE REFERRED TO IN ARTICLE 11 OF IMPLEMENTING REGULATION (EU) 2019/1793 FOR THE ENTRY INTO THE UNION OF CERTAIN FOOD OR FEED

General

To positively select any option, please tick or mark the relevant box with a cross (X).

Whenever mentioned, ‘ISO’ means the international standard two-letter code for a country, in accordance with the international standard ISO 3166 alpha-2 (1).

Only one of the options may be selected in boxes I.15, I.18, I.20.

Unless otherwise indicated, the boxes are compulsory.

If the consignee, the entry border control post (BCP) or the transport details (that is to say, the means and date) change after the certificate has been issued, the operator responsible for the consignment must advise the competent authority of the Member State of entry. Such a change shall not result in a request for a replacement certificate.

In case the certificate is submitted in IMSOC, the following applies:

— the entries or boxes specified in Part I constitute the data dictionaries for the electronic version of the official certificate;

— the sequences of boxes in part I of the model official certificate and the size and shape of those boxes are indicative;

— where a stamp is required, its electronic equivalent is an electronic seal. Such seal shall comply with the rules for the issuance of electronic certificates referred to in Article 90(f) of Regulation (EU) 2017/625.

Part I: Details of the dispatched consignment

Country: The name of the third country issuing the certificate. Box I.1. Consignor/Exporter: the name and address (street, city and region, province or state, as appropriate) of the natural or legal person dispatching the consignment that must be located in the third country. Box I.2. Certificate reference No: the unique mandatory code assigned by the competent authority of the third country in accordance with its own classification. This box is compulsory for all certificates not submitted in IMSOC. Box I.2.a IMSOC reference No: the unique reference code automatically assigned by IMSOC, if the certificate is registered in IMSOC. This box must not be completed if the certificate is not submitted in IMSOC. Box I.3. Central competent authority: name of the central authority in the third country issuing the certificate. Box I.4. Local competent authority: if applicable, the name of the local authority in the third country issuing the certificate. Box I.5. Consignee/Importer: name and address of the natural or legal person to whom the consignment is intended in the Member State. Box I.6. Operator responsible for the consignment: the name and address of the person in the European Union in charge of the consignment when presented to the BCP and who makes the necessary declarations to the competent authorities either as the importer or on behalf of the importer. This box is optional. Box I.7. Country of origin: the name and ISO code of the country where the goods are originating from, grown, harvested or produced. Box I.8. Not applicable. Box I.9. Country of destination: the name and ISO code of the European Union country of destination of the products. Box I.10. Not applicable. Box I.11. Place of dispatch: the name and address of the holdings or establishments from which the products come from. Any unit of a company in the food or feed sector. Only the establishment shipping the products is to be named. In the case of trade involving more than one third country (triangular movement), the place of dispatch is the last third-country establishment of the export chain from which the final consignment is transported to the European Union. Box I.12. Place of destination: this information is optional. For the placing on the market: the place where the products are sent for final unloading. Give the name, address and approval number of the holdings or establishments of the place of destination, if applicable. Box I.13. Place of loading: not applicable. Box I.14. Date and time of departure: the date when the means of transport departs (aeroplane, vessel, railway or road vehicle). Box I.15. Means of transport: means of transport leaving the country of dispatch. Mode of transport: aeroplane, vessel, railway, road vehicle or other. ‘Other’ means modes of transport not covered by Council Regulation (EC) No 1/2005 (2). Identification of the means of transport: for aeroplanes the flight number, for vessels the ship name(s), for railways the train identity and wagon number, for road transports the registration number plate with trailer number plate if applicable. In the case of a ferry, state the identification of the road vehicle, the registration number plate with trailer number plate if applicable, and the name of the scheduled ferry. Box I.16. Entry BCP: state the name of the BCP and its identification code assigned by IMSOC. Box I.17. Accompanying documents: Laboratory report: indicate the reference number and the date of issuance of the report/results of laboratory analyses referred to in Article 10 of Implementing Regulation (EU) 2019/1793 (this Regulation). Other: the type and reference number of document must be stated when a consignment is accompanied by the other documents such a commercial document (for example, the airway bill number, the bill of lading number or the commercial number of the train or road vehicle). Box I.18. Transport conditions: category of required temperature during the transport of products (ambient, chilled, frozen). Only one category may be selected. Box I.19. Container No/Seal No: if applicable, the corresponding numbers. The container number must be provided if the goods are transported in closed containers. Only the official seal number must be stated. An official seal applies if a seal is affixed to the container, truck or rail wagon under the supervision of the competent authority issuing the certificate. Box I.20. Goods certified as: state the intended use for products as specified in the relevant European Union official certificate. Human consumption: concerns only products intended for human consumption. Feedingstuff: concerns only products intended for animal feed. Box I.21. Not applicable Box I.22. For internal market: for all consignments destined to be placed on the market in the European Union. Box I.23. Total number of packages: the number of packages. In the case of bulk consignments, this box is optional. Box I.24. Quantity: Total net weight: this is defined as the mass of the goods themselves without immediate containers or any packaging. Total gross weight: overall weight in kilograms. This is defined as the aggregate mass of the products and of the immediate containers and all their packaging, but excluding transport containers and other transport equipment. Box I.25. Description of goods: State the relevant Harmonised System code (HS code) and the title defined by the World Customs Organisation as referred to in Council Regulation (EEC) No 2658/87 (3). This customs description shall be supplemented, if necessary, by additional information required to classify the products. Indicate the species, types of products, the number of packages, type of packaging, batch number, net weight, and final consumer (i.e. products are packed for final consumer). Species: the scientific name or as defined in accordance with European Union legislation. Type of packaging: identify the type of packaging according to the definition given in Recommendation No 21 (4) of UN/CEFACT (United Nations Centre for Trade Facilitation and Electronic Business).

Part II: Certification

This part must be completed by a certifying officer authorised by the competent authority of the third country to sign the official certificate, as provided for in Article 88(2) of Regulation (EU) 2017/625.

Box II. Health information: please complete this part in accordance with the specific European Union health requirements relating to the nature of the products and as defined in the equivalence agreements with certain third countries or in other European Union legislation, such as that for certification. Select among points II.2.1, II.2.2, II.2.3 and II.2.4, the point corresponding to the category of product and the hazard for which the certification is given. In case the official certificates is not submitted in IMSOC, the statements which are not relevant must be crossed out, initialled and stamped by the certifying officer, or completely removed from the certificate. In case the certificate is submitted in IMSOC, the statements which are not relevant must be crossed out or completely removed from the certificate. Box II.a. Certificate reference No: same reference code as in box I.2. Box II.b. IMSOC reference No: same reference code as in box I.2.a. Mandatory only for official certificates issued in IMSOC. Certifying officer: Official of the competent authority of the third country authorised to sign official certificates by such authorities: Indicate the name in capital letters, qualification and title, where applicable, identification number and original stamp of the competent authority and date of signature.

(1) List of country names and code elements under: http://www.iso.org/iso/country_codes/iso-3166-1_decoding_table.htm

(2) Council Regulation (EC) No 1/2005 of 22 December 2004 on the protection of animals during transport and related operations and amending Directives 64/432/EEC and 93/119/EC and Regulation (EC) No 1255/97 (OJ L 3, 5.1.2005, p. 1).

(3) Council Regulation (EEC) No 2658/87 of 23 July 1987 on the tariff and statistical nomenclature and on the Common Customs Tariff (OJ L 256, 7.9.1987, p. 1).

(4) Last version: Revision 9 Annexes V and VI as published on: http://www.unece.org/tradewelcome/un-centre-for-trade-facilitation-and-e-business-uncefact/outputs/cefactrecommendationsrec-index/list-of-trade-facilitation-recommendations-n-21-to-24.ahtml.