⸥᭽ᑼ╙䋱ภ
⁅›∛੍㒐ᴺ䈶ኅ⇓વᨴ∛੍㒐ᴺ䈮ၮ䈨䈒›䈱ャ䈮㑐䈜䉎ዯᦠ 㪥㪦㪫㪠㪝㪠㪚㪘㪫㪠㪦㪥㩷㪝㪦㪩㩷㪠㪤㪧㪦㪩㪫㩷㪦㪝㩷㪛㪦㪞㪪 㪬㪥㪛㪜㪩㩷㪫㪟㪜㩷㪩㪘㪙㪠㪜㪪㩷㪧㪩㪜㪭㪜㪥㪫㪠㪦㪥㩷㪣㪘㪮㩷㪘㪥㪛㩷㪫㪟㪜㩷㪛㪦㪤㪜㪪㪫㪠㪚㩷㪘㪥㪠㪤㪘㪣㩷㪠㪥㪝㪜㪚㪫㪠㪦㪬㪪㩷㪛㪠㪪㪜㪘㪪㪜㪪㩷㪚㪦㪥㪫㪩㪦㪣㩷㪣㪘㪮
ᐕ䇭䇭䇭䇭䇭䇭䇭䇭ᣣ
ዯ⠪ᚲ᳁ฬ䈶ㅪ⛊వ
Year䇭䇭Month䇭 Day
Name and address of applicant ᳁ฬ䇭Name 䋺 䋨
䋩䇭䇭䇭ශ
ᚲ䇭Address 䋺 㔚⇟ภ Telephone 䋺 FAX 䋺 E-mail 䋺
േ‛ᬌ∉ᚲ㐳䇭Ლ To the chief of Animal Quarantine Service
䇭േ‛䉕ャ䈚䈢䈇䈱䈪䇮ਅ⸥䈱䈫䈍䉍ዯ䉕䈇䈢䈚䉁䈜䇯 䇭䇭I hereby notify for the importation of the undermentioned animal(s). േ‛䈱⒳㘃 Species of animal(s)
㗡ᢙ Quantity
↢ᐕᣣ䋨ᐕ㦂 䋩 Date of birth (Age)
ᕈ Sex
࿖ฬ Country of export
ャ䈱႐ᚲ Scheduled place of arrival
タ੍ቯ䈶タ੍ቯᐕᣣ Scheduled date and place of embarkation ャ䈱ᤨᦼ䋨⌕੍ቯᐕᣣ䋩 Scheduled date of arrival (year/month/day)
タ੍ቯ⦁⥾ 䋨⥶ⓨᯏ䋩 ฬ Name of scheduled vessel (or flight No.)
⩄ㅍੱᚲ᳁ฬ Name and address of consignor ⩄ฃੱᚲ᳁ฬ Name and address of consignee
⸥ᵈᗧ㪑䇭 㪈㪅᳁ฬ䉕⥄⟑䈜䉎႐ว䈮䈍䈇䈩䈲䇮ශ䉕⋭⇛䈜䉎䈖䈫䈏䈪䈐䉎䇯 2.ᰴ㗁䈱䈠䈱ઁෳ⠨䈫䈭䉎䈼䈐㗄ᰣ䈮䈲䇮↪ㅜ䇮ะ䇮䋨㘺㙃ᣉ⸳ฬ⒓䈶ᚲ䋩䇮䈠䈱ઁャᬌᩏෳ⠨䈫䈭䉎䈼䈐㗄䉕⸥タ䈜䉎䈖䈫䇯 In the last column of next page, please note the information such as the use of the animal(s), the destination, name and address of the facility in which the animal(s) is/are kept, etc. 䇭
䈠䈱ઁෳ⠨䈫䈭䉎䈼䈐㗄 (Other useful information) ฬ⒓ Name of animal(s) ⼂ᣇᴺ䋨䊙䉟䉪䊨䉼䉾䊒╬䋩 Means for identification (e.g.microchip) ᮡ⼂ᐕᣣ Date of identification(year/month/day)
⼂⇟ภ/䊙䊷䉪 Identification number/Mark ᮡ⼂ㇱ Location of identification
㩷䊙䉟䉪䊨䉼䉾䊒䋨䊥䊷䉻䊷䋩䈱⒳㘃 Type of microchip (reader)
ຠ⒳ Breed
Ძ⦡ Color
↪ㅜ Use
ャㅍᒻᘒ䋨⽻‛䈲៤Ꮺຠ䋩 cargo or hand luggage
㐳 Length
䇭 䌣䌭
㜞 Height
䇭
㊀ Weight
䌣䌭
䌫䌧䇭
䋨㘺㙃ᣉ⸳ฬ⒓䈶ᚲ䋩 Name and address of the facility in which the animal(s) is/are kept ะ䋨ฬ⒓䈶ᚲ䋩 Name and address of destination ㆊ䋱ᐕએౝ䈱⸰࿖䈶䈠䈱ᐕᣣ Countries visited in the past 12 months and the date of visits ⁅›∛੍㒐ធ⒳ Rabies vaccination
ធ⒳ᐕᣣ Date of vaccination (year/month/day)
ലᦼ㒢 Date of expiry (year/month/day)
੍㒐ᶧ䈱⒳㘃 Kind of vaccine
੍㒐ᶧ䈱ຠฬ䈶ㅧળ␠ Name of product and manufacturer
ណⴊ೨ Before blood sampling
ណⴊᓟ㩷Booster(if any)
⁅›∛᛫ᬌᩏ
㩷ណⴊᣣ
᛫ଔ Antibody titer
Rabies serological test Date of blood sampling (year/month/day)
IU/ml
ᬌᩏᯏ㑐ฬ䈶ᚲ Name and address of the designated laboratory 䈠䈱ઁ䈱੍㒐ធ⒳ Other vaccination
⠨ Remarks
䇭
ធ⒳ᐕᣣ Date of vaccination (year/month/day)
ലᦼ㒢 Date of expiry (year/month/day)
੍㒐ᶧ䈱⒳㘃 Kind of vaccine
੍㒐ᶧ䈱ຠฬ䈶ㅧળ␠ Name of product and manufacturer
