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Certificate of Health of the Origin of Live Fish/Fish Ova

I,             as an authorized Fish Health Official of the Federal State Government of           , certify that the source of live fish/fish ova given below has been inspected by methods approved by the Government of and that no evidence was found of the diseases or disease agents of live fish as required by the Fish Health Regulations of the Government of

Source of Live Fish/Fish Ova
and full Postal Address

In addition, record any other diseases or disease agents found during the previous two years in farm stock:

Record of the dates of the last four inspections of the site.

Signature in Ink of Certifying Officer


I                                        (Name in Print), owner/manager of the site of origin, as recorded below, of all the fish/ova in this consignment which were last inspected on                       (Date) declare that no introductions of fish or fish eggs from an uncertified source as defined by the Fish Health Regulations of the Government of                                         governing the import of live fish/fish ova has been made to this site and that the shipment described below is derived solely from this site.

The shipment is due to depart                                                                           on                                   by                                                              
(City and County)   (Date)   (Carrier Name)
with anticipated arrival in                                                at                                                                 on                                                 and consists
(Port/Airport) (Date)
(Species, numbers, age, and size) Date

Signature of Owner/Manager in Ink

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