GREAT BRITAIN, CHANNEL ISLANDS AND ISLE OF
MAN
Pet health certificate for the non-commercial movement to Great Britain, Channel Islands and Isle of Man
of dogs, cats or ferrets in accordance with
Regulation (EU) No 576/2013
COUNTRY: Veterinary certificate to Great Britain,
Channel
Islands and Isle of Man
I.1. Consignor I.2 Certificate reference number
Name Jenniffer Dujarric Pimentel 125891
Address Avenida Paseo de los Reyes
Catolicos #7, Arroyo Hondo
I.3. Consignee
Name Taciana Baez Mainardi
Address 19 College Road, Bangor, Wales, United
Kingdom
Tel. 829-551-4968 Postal code LL57 2AN
Tel. 809-705-2621
I.4. Central competent authority I.5. Country of origin
Ministerio de Agricultura Dominican Republic
I.6. Local competent authority I.7. ISO Code of country of origin
Dirección General de Ganadería DOM
I.8. Description of commodity I.9. Commodity code (HS code)
010619
Canine
I.10. Quantity I.11. Commodities certified for: Pets
I.12. Identification of the commodities
Identification
Species
Identification system Date of birth
(Scientific Sex Colour Breed
number [transponder/ [dd/mm/yyyy]
name)
tattoo (10)]
Canis Lupus Female Black Schnauzer 956000011487545 Transponder 24/07/2022
Familiaris
ar
P
Non-commercial movement to Great Britain, Channel Islands
COUNTRY:
and Isle of Man of dogs, cats or ferrets in accordance with
Regulation (EU) No 576/2013
II. Health information II.a. Certificate reference number
125891
l, the undersigned official veterinarian (1) / veterinarian authorised by the competent authority (1) of
.......DOMINICAN REPUBLIC........................................................... (insert name of country) certify that:
Purpose/nature of journey attested by the owner
II.1. the attached declaration (2) by the owner or the natural person who has authorisation in
writing from the owner to carry out the non-commercial movement of the animals on behalf
of the owner, supported by evidence (3), states that the animals described in Box l.12 will
accompany the owner or the natural person who has authorisation in writing from the
owner to carry out the non-commercial movement of the animals on behalf of the owner
within not more than 5 days of his movement and are not subject to a movement that aims at
their sale or a transfer of ownership, and during the non-commercial movement will remain
under the responsibility of
(1) either [the owner;]
(1) or [the natural person who has authorisation in writing from the owner to carry out the
non-commercial movement of the animals on behalf of the owner,]
(1) or [the natural person designated by a carrier contracted by the owner to carry out the
non-commercial movement of the animals on behalf of the owner;]
(1) either lI.2. the animals described in Box l.12 are moved in a number of five or less;
(1) or lI.2. the animals described in Box 1.12 are moved in a number of more than five are more
than 6 months old and are going to participate in competitions exhibitions or sporting
events or in training for those events, and the owner or the natural person referred to
in point II.1 has provided evidence (3) that the animals are registered
(1) either [to attend such event;]
(1) or [with an association organising such events;]
Non-commercial movement to Great Britain, Channel Islands
and Isle of Man of dogs, cats or ferrets in accordance with of
COUNTRY: Regulation (EU) No 576/2013
II. Health information II.a. Certificate reference number
125891
Attestation of rabies vaccination and rabies antibody titration test
II.3. the animals described in Box I.12 were at least 12 weeks old at the time of vaccination against rabies and at
least 21 days have elapsed since the completion of the primary anti-rabies vaccination ( 4) carried out in
accordance with the validity requirements set out in Annex III to Regulation (EU) No 576/2013 and any
subsequent revaccination was carried out within the period of validity of the preceding vaccination (5); and
(') either [II.3.1 the animals described in Box I.12 come from a third country listed in Annex II to Implementing
Regulation (EU) No 577/2013, either directly, through a third country listed in Annex II to
Implementing Regulation (EU) No 577/2013 or through a third country other than those listed in
Annex II to Implementing Regulation (EU) No 577/2013 in accordance with point (c) of Article 12(1)
of Regulation (EU) No 576/2013 (6), and the details of the current anti-rabies vaccination are
provided in the table below:]
(') or [II.3.1 the animals described in Box I.12 come from, or are scheduled to transit through a third
country other than those listed in Annex II to Implementing Regulation (EU) No 577/2013 and a
rabies antibody titration test (7), carried out on a blood sample taken by the veterinarian authorised
by the competent authority on the date indicated in the table below not less than 30 days after the
preceding primary vaccination within a current valid vaccination series and at least 3 months prior to
the date of issue of this certificate, proved an antibody titre equal to or greater than 0,5 IU/ml (8) and
any subsequent revaccination was carried out within the period of validity of the preceding
vaccination (5), and the details of the current anti-rabies vaccination and the date of sampling for
testing the immune response are provided in the table below:]
Validity of
Transponder or vaccination
tattoo Date of the
Name and [dd/mm/yyyy] blood sampling
Date of Batch
manufacturer
Alphanumeric Date of vaccination number
code of the implantation of vaccine
[dd/mm/yyyy] [dd/mm/yyyy]
From
animal and/or
To
reading (9)
[dd/mm/yyyy]
95600001148754 12/05/2023 15/05/2024 Rabia A607A05 15/05/ 15/05/ 14/06/2023
5 2024 2025
Nobivac
95600001148754 12/05/2023 15/05/2023 Rabigen 8YJJ 15/05/ 15/05/ 14/06/2023
5 mono 2023 2024
Virbac
Non-commercial movement to Great Britain, Channel Islands
and Isle of Man of dogs, cats or ferrets in accordance with of
COUNTRY: Regulation (EU) No 576/2013
II. Health information II.a. Certificate reference number
125891
Attestation of anti-parasite treatment
(') either [II.4. the dogs described in Box I.12 are destined for Great Britain, Channel Islands and Isle of Man and have
been treated against Echinococcus multilocularis and the details of the treatment carried out by the
administering veterinarian in accordance with Article 6 of Delegated Regulation (EU) No 2018/772 ( 10)
(11) are provided in the table below.]
(') or [II.4. the dogs described in Box I.12 have not been treated against Echinococcus multilocularis (10).]
Anti-echinococcus
Administering veterinarian
treatment
Transponder or Name and Date [dd/mm/yyyy]
tattoo number of the dog manufacturer and time of treatment Name in capitals, stamp and signature
of the product [00:00]
956000011487545 Zipyran 02/09/2024
Plus/Calier 08:00 JENNIFFER DUJARRIC PIMENTEL
Notes
(a) This certificate is meant for dogs (Canis Lupus familiaris) cats (Felis silvestris Cetus) and ferrets (Mustela
putorius furo).
(b) This certificate is valid for 10 days from the date of issue by the official veterinarian until the date of the
documentary and identity checks at the designated point of entry into Great Britain, Channel Islands and Isle of
Man
In the case of transport by sea, that period of 10 days is extended by an additional period corresponding
to the duration of the journey by sea
Part I:
Box I.3: Consignee: indicate Great Britain, Channel Islands and Isle of Man as destination.
Box I.12: Identification system: select of the following: transponder or tattoo.
Identification number: indicate the transponder or tattoo alphanumeric code.
Date of birth/breed as stated by the owner.
COUNTRY: Non-commercial movement to Great Britain, Channel Islands
and Isle of Man of dogs, cats or ferrets in accordance with of
Regulation (EU) No 576/2013
II. Health information II.a. Certificate reference number
125891
Part II:
(1 ) Keep as appropriate.
(2 ) The declaration referred to in point II.1 shall be attached to the certificate and comply with the model and
additional requirements set out in Part 3 of Annex IV to Implementing Regulation (EU) No 577/2013,
(3 ) The evidence referred to in point Il.1 (e.g. boarding pass, flight ticket) and in point II.2 (e.g. receipt of
entry to the event, proof of membership) shall be surrendered on request by the competent authorities
responsible for the checks referred to in point (b) of the Notes.
(4 ) Any revaccination must be considered a primary vaccination if it was not carried out within the period of
validity of a previous vaccination.
(5 ) A certified copy of the identification and vaccination details of the animals concerned shall be attached to
the certificate.
(6 ) The third option is subject to the condition that the owner or the natural person referred to in point II.1
provides, on request by the competent authorities responsible for the checks referred to in point (b), a
declaration stating that the animals have had no contact with animals of species susceptible of rabies
and remain secure within the means of transport or the perimeter of an international airport during the
transit through a third country other than those listed in Annex Il to Implementing Regulation
(EU) No 577/2013. This declaration shall comply with the format, layout and language requirements set
out in Parts 2 and 3 of Annex I to Implementing Regulation (EU) No 577/2013.
(7 ) The rabies antibody titration test referred to in point II.3.1:
must be carried out on a sample collected by a veterinarian authorised by the competent authority,
at least 30 days after the primary rabies vaccination within a current valid vaccination series and 3
months before the date of import;
must measure a level of neutralising antibody to rabies virus in serum equal to or greater than 0,5
EU/ml;
must be performed by a laboratory approved in accordance with Article 3 of Council Decision
2000/258/EC (list of approved laboratories available at https://ec.europa.eu/food/animals/pet-
movement/approved-labs_en);
does not have to be renewed on an animal, which following that test with satisfactory results, has
been revaccinated against rabies within the period of validity of a previous vaccination.
A certified copy of the official report from the approved laboratory on the results of the rabies antibody
test referred to in point II.3.1 shall be attached to the certificate.
(8 ) By certifying this result, the official veterinarian confirms that he has verified, to the best of his ability and
where necessary with contacts with the laboratory indicated in the report, the authenticity of the
laboratory report on the results of the antibody titration test referred to in point II.3,1.
(9 ) In conjunction with footnote (6), the marking of the animals concerned by the implantation of a
transponder or by a clearly readable tattoo applied before 3 July 2011 must be verified before any entry
is made in this certificate and must always precede any vaccination, or where applicable, testing carried
out on those animals.
COUNTRY: Non-commercial movement to Great Britain, Channel Islands
and Isle of Man of dogs, cats or ferrets in accordance with of
Regulation (EU) No 576/2013
II. Health information II.a. Certificate reference number
125891
(10) The treatment against Echinococcus multilocularis referred to in point II.4 must:
be administered by a veterinarian within a period of not more than 120 hours and not less than 24
hours before the time of the scheduled entry of the dogs into Great Britain, Channel Islands and
Isle of Man;
consist of an approved medicinal product which contains the appropriate dose of praziquantel or
pharmacologically active substances, which alone or in combination, have been proven to reduce
the burden of mature and immature intestinal forms of Echinococcus multilocularis in the host
species concerned.
(11) The table referred to in point I1.4 must be used to document the details of a further treatment if administered
after the date the certificate was signed and prior to the scheduled entry into Great Britain, Channel
Islands and Isle of Man.
Official veterinarian/Authorised veterinarian (delete as appropriate)
Name (in capital letters): Qualification and title:
Address
Telephone:
Date: Signature:
Stamp:
Endorsement by the competent authority (not necessary when the certificate is signed by an official veterinarian)
Name (in capital letters): Qualification and title:
Address
Telephone:
Date: Signature:
Stamp:
Official at point of entry in GB
Name (in capital letters): Title:
Address
Telephone:
E-mail address:
Date of completion of documentary and identity checks by authorised body:
Signature:
Stamp:
Explanatory notes for completing the health certificate
(a) Where the certificate states that certain statements shall be kept as
appropriate, statements which are not relevant may be crossed out and
initialled and stamped by the official veterinarian, or completely deleted from
the certificate.
(b) The original of each certificate shall consist of a single sheet of paper, or,
where more text is required it must be in such a form that all sheets of paper
required are part of an integrated whole and indivisible.
(c) The certificate shall be drawn up in English. It shall be completed in block
letters in English.
(d) If additional sheets of paper or supporting documents are attached to the
certificate, those sheets of paper or document shall also be considered as
forming part of the original of the certificate by the application of the signature
and stamp of the official veterinarian, on each of the pages.
(e) When the certificate, including additional sheets referred to in point (d),
comprises more than one page, each page shall be numbered (page number
of total number of pages) at the end of the page and shall bear at the top of
each page the certificate reference number that has been designated by the
competent authority.
(f) The original of the certificate shall be issued by an official veterinarian of the
country of dispatch or by an authorised veterinarian and subsequently
endorsed by the competent authority of the country of dispatch. The competent
authority of the country of dispatch shall ensure that rules and principles of
certification equivalent to those laid down in Directive 96/93/EC are followed.
(g) The colour of the signature shall be different from that of printing. This
requirement also applies to stamps other than those embossed or
watermarked.
(h) The certificate reference number referred to in boxes I.2 and II.a shall be
issued by the competent authority of the country of dispatch.
Written declaration referred to in Article 25(3) of of Regulation (EU) No 576/2013
Section A
Model of declaration
I, the undersigned
....................................................................................................................................................
[owner or the natural person who has authorisation in writing from the owner to carry out the non-
commercial movement on behalf of the owner(1)]
declare that the following pet animals are not subject to a movement that aims at their
sale or a transfer of ownership and will accompany the owner or the natural person
who has authorisation in writing from the owner to carry out the non-commercial
movement on behalf of the owner(1) within not more than 5 days of his movement.
Transponder/tattoo(1) alphanumeric code Animal health certificate number
956000011487545 125891
During the non-commercial movement, the above animals will remain under the
responsibility of
(1)
either [the owner];
(1)
or [the natural person who has authorisation in writing from the owner to
carry out the non-commercial movement on behalf of the owner]
(1)
or [the natural person designated by the carrier contracted to carry out the
non-
commercial movement on behalf of the owner:
…………………………………….
(insert name of the carrier)]
Place and date: …………………………………………………….
Signature of the owner or natural person who has authorisation in writing from
the owner to carry out the non-commercial movement on behalf of the owner (1):
…………………………………………………….
(1)
delete as appropriate.
