[별지 제14호 서식] <신설 2016.7.1>

94, Dasom 2-ro, Government Complex-Sejeong, Sejeong-si, Korea 339-012. Tel: +82-44-201-2389, Fax: +82-44-863-9218

(339-102) 세종특별자치시 다솜2로 94 정부세종청사    전화 : 044-201-2389  전송 : 044-863-9218

Page No  :

Advance Registration Health Declaration

(수입국 사전등록용 위생증명서)

TO WHOM IT MAY CONCERN :

MM/DD/YY

I,                                   the undersigned government quarantine officer of Animal and Plant Quarantine Agency (QIA) of Korea, with reference to the animal feed product described as following, certify that;

(농림축산검역본부 검역관 000은 사료 제품에 대하여 다음 사항을 증명합니다.)

< 주요 증명내용 예시 >

• The product does not contain any substances derived from animal

(동 제품은 동물유래 물질이 포함되지 않음)

• The product was processed in a manner as to prevent contamination by infectious animal disease pathogens (제품은 가축질병병원체에 오염을 방지할 수 있는 방법으로 가공처리 되었음)

￭

Name of establishment (작업장명):

￭

Address of establishment (작업장 주소):

￭

Country of destination (도착국):

￭

Name and address of consignor (수출 화주명, 주소):

￭

Registration of manufacturing No. (제조업등록번호):

￭

Description of the product (제품)

Classfication (사료구분)	Name of product (제품명)	The name of an article (사료의 명칭)	Registration of feed ingredients No. (성분등록번호)

Remark(비고) :

Sincerely Yours,

Director of Livestock Management Division

Livestock policy Bureau

Ministry of Agriculture, Food and Rural Affairs

Republic of Korea

(Stamp or Signature)

210㎜×297㎜[백상지 80g/㎡]