[별지 제 23호]

Republic of Korea

Ministry for Food, Agriculture, Forestry and Fisheries

Animal, Plant and Fisheries Quarantine and Inspection Agency

CERTIFICATE OF TREATMENT

_____________ Quarantine and Inspection Agency for Animal, Plant and Fisheries  No : ________________

TO : The Plant Protection Organization of _________________________

________________________________________________________________________________________________________________

DESCRIPTION OF CONSIGNMENT

Name of vessel : ________________________________________________________________

Number of Bill of Lading : _______________________________________________________

Name and address of exporter : __________________________________________________________

Declared name and address of consignee : ________________________________________________

Place of origin : _________________________________________________________________________

Destination : ____________________________________________________________________

Name of produce and quantity : __________________________________________________

______________________________________________________________________________________________

This is to certify that the goods described above have been treated as follows

________________________________________________________________________________________________________________

DESCRIPTION OF TREATMENT

Date : _____________                 Treatment : _____________________________________________

Chemical(active ingredient) : ________   Duration and temperature : ________________________________

Concentration : ________________      Additional information : _________________________________

Name and address of fumigation company  : ___________________________________________________

______________________________________________________________________________________________

Place of issue : _____________________________________________________________________

Name of authorized officer : ______________________________________________________

Date : _____________________ (Signature) ________________________

No financial liability with respect to this certificate shall attach to the Quarantine and Inspection Agency for Animal, Plant and Fisheries or to any of its officers or representatives.

210mm×297mm(일반용지 60g/㎡(재활용품))